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Surgical ICU recidivism after cardiac operations
W E Cohn1, F W Sellke, C Sirois
1Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Chest
|September 24, 1999
Summary
Reducing intensive care unit (ICU) length of stay (LOS) after cardiac surgery is linked to higher ICU recidivism rates. Patients with longer initial ICU stays are more likely to be readmitted.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Decreasing intensive care unit (ICU) length of stay (LOS) after cardiac operations may inadvertently increase ICU recidivism.
- This increased readmission rate could negate the benefits of early discharge.
Purpose of the Study:
- To investigate the relationship between initial ICU LOS and ICU recidivism after cardiac operations.
- To identify predictors of ICU readmission in this patient population.
Main Methods:
- Analysis of 2,228 patients undergoing cardiac operations between January 1, 1994, and January 1, 1998.
- Data collected included initial and secondary ICU LOS, reasons for return, and mortality.
- Statistical analysis to determine trends and predictors of ICU recidivism.
Main Results:
- A significant decrease in initial ICU LOS was observed from 1994 to 1997 (median from 31 h to 24 h).
- Concurrently, ICU recidivism increased significantly (from 3.9% to 8.4%).
- Longer initial ICU LOS was strongly associated with a higher incidence of readmission (p = 0.0008). Predictors included preoperative congestive heart failure, lower ejection fraction, and postoperative increased weight gain or longer ventilator time.
Conclusions:
- Initial ICU LOS after cardiac surgery has decreased, accompanied by a significant rise in ICU recidivism.
- Patients readmitted to the ICU typically had longer initial stays.
- Efforts to reduce ICU recidivism should target patients with poorer preoperative cardiac function and those with extended initial ICU stays.