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Determinants of prolonged intensive care unit stay after cardiac surgery in the elderly
Francesco Cacciatore1, Clara Belluomo Anello, Nicoletta Ferrara
1Campoli/Telese Scientific Institute, Salvatore Maugeri Foundation, IRCCS, Telese, Benevento 82131, Italy. francesco.cacciatore@fsm.it
Insights
Pre-operative assessment identifies elderly cardiac surgery patients at risk for prolonged ICU stays. Female sex, NYHA class ≥3, CIRS, and PASE score predict longer intensive care unit (ICU) stays, impacting functional recovery.
Area of Science:
- Cardiology
- Geriatric Medicine
- Intensive Care Medicine
Background:
- Increasing number of elderly patients undergoing cardiac surgery.
- Identification of risk factors for prolonged intensive care unit (ICU) stay is crucial.
- Understanding post-ICU outcomes in this population is essential for rehabilitation planning.
Purpose of the Study:
- To evaluate pre-operative risk factors for ICU stay longer than 3 days in elderly cardiac surgery patients.
- To determine the influence of prolonged ICU stay on disability, functional recovery, and rehabilitation length of stay.
- To identify predictors for extended ICU duration in older adults post-cardiac procedures.
Main Methods:
- Consecutive evaluation of 250 elderly (≥65 years) cardiac surgery patients entering cardiac rehabilitation.
- Univariate and multivariate analyses to identify risk factors for ICU stay ≥3 days.
- Assessment of functional recovery using 6-minute walking test (6MWT) and Barthel Index (BI), and rehabilitation length of stay (LOS).
Main Results:
- 28.8% of patients experienced ICU stay ≥3 days.
- Predictors for prolonged ICU stay included female sex, NYHA class ≥3, higher CIRS score, and lower PASE score.
- Prolonged ICU stay was negatively associated with 6MWT, BI at entry, and BI percent recovery, and positively associated with longer rehabilitation LOS.
Conclusions:
- Pre-operative comprehensive assessment can identify elderly cardiac surgery patients at risk for prolonged ICU stays.
- Identifying these predictors aids in tailoring cardiac rehabilitation programs for better functional recovery and reduced disability.
- Early identification of at-risk individuals can optimize resource allocation and patient management in cardiac rehabilitation.
Objectives:
In the last decade, there has been a rapid increase in the number of elderly patients referred for cardiac surgery. Recent studies have identified risk factors for prolonged intensive care unit (ICU) stay in cardiac surgery patients. The aims of this study was to evaluate pre-operative risk factors for ICU stay longer than 3 days in a cardiac surgery elderly population, and whether prolonged ICU stay may influence disability, functional recovery and length of rehabilitation.
Methods:
Two hundred and fifty elderly (≥65 years) cardiac surgery patients were consecutively evaluated at enter in cardiac rehabilitation after ICU dismissal from January 2008 to July 2009. Univariate and multivariate analyses for risk factors were performed for ICU stay longer than 3 days. Thereafter, 6-minute walking test (6MWT), Barthel Index (BI), BI percent recovery and length of stay (LOS) in rehabilitation were evaluated.
Results:
Mean age was 72.9±4.8 yrs, 170 (68%) patients underwent cardiac surgery for coronary artery by-pass grafting (CABG), 56 (22.4%) for valve replacement and 24 (9.6%) for both CABG and valve replacement. Mean ICU stay was 1.9±1.5 days and 72 patients (28.8%) spent more than 3 days in ICU. Age, New York Heart Association class ≥3, Cumulative Illness Rating Scale (CIRS) score, prevalence of stroke and renal failure were significantly higher in patients with than in those without ICU stay ≥3 days. Off-pump CABG, Physical Activity Scale for the Elderly (PASE), BI and 6MWT were significantly lower in patients with than in those without ICU stay ≥3 days. Multivariate analysis shows that female sex, a NYHA class ≥3, CIRS and PASE score are predictors of ICU stay ≥3 days independently of age, off-pump CABG, stroke and renal failure. Multiple linear regression shows that ICU stay ≥3 days is negatively associated with 6MWT, BI at entry and BI percent recovery, whereas it is positively associated with a longer rehabilitation LOS.
Conclusions:
Pre-operative comprehensive assessment in the elderly could help to identify predictors of long ICU stay after cardiac surgery. This approach could help to better define the elderly cardiac surgery patients and their needs throughout the cardiac rehabilitation program in order to maximize functional capacity recovery, reducing disability and rehabilitation LOS.
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