The predictors and outcome of recidivism in cardiac ICUs
Hunaid A Vohra1, Ira R A Goldsmith, Michael D Rosin
1Cardio-thoracic Surgical Unit, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK. hunaidvohra@yahoo.co.uk
Insights
Cardiac surgery patients requiring intensive care unit (ICU) readmission, or recidivism, were more common after valve procedures than bypass surgery alone. Respiratory failure was the leading cause, highlighting the need for early cardio-respiratory support.
Area of Science:
- Cardiovascular Surgery
- Intensive Care Medicine
- Patient Outcomes
Background:
- Reinstitution of step-up care (recidivism) after cardiac surgery may increase mortality, but this is not widely reported.
- Understanding the factors and outcomes associated with ICU recidivism is crucial for improving patient care.
Purpose of the Study:
- To determine the reasons for intensive care unit (ICU) readmission (recidivism) in cardiac surgery patients.
- To analyze the outcomes of ICU recidivism, including length of stay and in-hospital mortality.
Main Methods:
- A retrospective study of 8113 consecutive patients undergoing coronary artery bypass grafting (CABG), valve surgery, or combined procedures.
- Analysis of patient data to identify reasons for ICU readmission, length of stay, and mortality.
Main Results:
- 2.3% of discharged patients required ICU recidivism, with a higher rate after valve surgery (3.9%) compared to CABG alone (1.8%).
- Respiratory failure (54.9%) was the primary reason for recidivism, followed by cardiovascular instability (23.1%) and bleeding (7.7%).
- Independent predictors of recidivism included respiratory complications, low cardiac output, renal failure, and bleeding requiring re-exploration. In-hospital mortality following recidivism was 32.4%.
Conclusions:
- Patients undergoing valve surgery +/- CABG have a higher likelihood of ICU recidivism than those undergoing CABG alone.
- Respiratory complications are the most frequent cause of recidivism, and patients requiring mechanical support are most vulnerable.
- Early management of cardio-respiratory issues is essential to reduce ICU recidivism in this patient population.
Objective:
Reinstitution of step-up care (recidivism) following cardiac surgery may be associated with increased mortality. This has, however, not been widely reported.
Methods:
We, therefore, studied 8113 consecutive patients who underwent coronary artery bypass grafting (CABG), valve replacement/repair or combined valve+CABG surgery between January 1996 and December 2003 to determine the reasons for readmission to the intensive care unit (ICU) and their outcomes in terms of length of stay in (i) the ICU (ii) hospital and (iii) the in-hospital mortality following recidivism.
Results:
Of the 7717 patients discharged out of the ICU, 2.3% (182) of patients [mean age 70.4+/-8.35 years (range 30-90 years); 65.4% (119) males] required step-up care. Recidivism was 1.8% (101 of 5633) following coronary artery by-pass grafting (CABG) and 3.9% (81 of 2084) following valve replacement/repair+/-CABG (P<0.05). The mean interval from ICU discharge to ICU recidivism was 6.6+/-8.4 days (range 6h to 28 days). The principal reasons for recidivism were (i) respiratory failure requiring reintubation and ventilation in 54.9% (n=100) of patients (ii) cardiovascular instability (including that secondary to dysrhythmias) and heart failure in 23.1% (n=42) (iii) renal failure requiring haemofiltration in 6.6% (n=12) (iv) sepsis in 1.1% (n=2) (v) cardiac tamponade/bleeding requiring re-exploration in 7.7% (n=14) and (vi) gastro-intestinal complications requiring laparotomy in 6.0% (n=11) patients. Multivariate analysis showed that, during primary ICU stay, respiratory complications, low cardiac output state, dysrhythmias, renal failure requiring haemofiltration and re-exploration for bleeding were independent predictors of recidivism. Following recidivism (i) the mean length of stay in the ICU was 6.65+/-6.2 days (range 4h to 51 days), (ii) mean hospital stay was 19.2+/-17.3 days (10-60 days) and (iii) the 30-day in-hospital mortality was 32.4%.
Conclusions:
Patients are more likely to require recidivism following valve surgery+/-CABG than CABG alone. Whilst respiratory complications were the most common reasons for recidivism in our study, patients who required mechanical supports to maintain vital functions following surgery were most prone to recidivism. Hence, efforts should be made to treat cardio-respiratory problems early in this group of patients to reduce ICU recidivism.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:26Cardiac Catheterization IV: Nursing Management
01:18Endocarditis III: Medical Management
01:29Endocarditis IV: Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:29Cardiomyopathy V: Interprofessional Care