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A case-control study of readmission to the intensive care unit after cardiac surgery
Rimantas Benetis1, Edmundas Sirvinskas, Birute Kumpaitiene
1Institute of Cardiology, Department of Cardiothoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Insights
Predictors of intensive care unit (ICU) readmission after cardiac surgery include older age, higher BMI, and non-elective procedures. Identifying high-risk patients can help reduce readmission rates and improve outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Cardiac surgery patients face risks of intensive care unit (ICU) readmission.
- Identifying predictors for ICU readmission is crucial for patient management and resource allocation.
Purpose of the Study:
- To identify predictors of repeated ICU admission in patients undergoing cardiac surgery.
- To inform strategies for reducing ICU readmission rates and associated mortality.
Main Methods:
- Retrospective analysis of 169 patients undergoing isolated coronary artery bypass grafting (CABG).
- Comparison of 54 patients readmitted to the ICU with 115 randomly selected control patients.
- Logistic regression analysis to determine independent predictors of ICU readmission.
Main Results:
- Independent predictors for ICU readmission include older age, BMI > 30 kg/m², EuroSCORE II > 3.9%, non-elective surgery, operation duration > 4 hours, bypass time > 103 min, mechanical ventilation > 530 min, and postoperative CNS disorders.
- Patients readmitted to the ICU had significantly higher hospital mortality (17%) compared to those not readmitted (3.8%).
Conclusions:
- Key patient groups at risk for ICU readmission after CABG include older individuals, those with higher BMI, and patients undergoing non-elective procedures or prolonged operations.
- Postoperative central nervous system disorders are a significant predictor of ICU readmission.
- Targeted optimization and careful discharge planning for high-risk patients may reduce ICU readmissions, mortality, and healthcare costs.
Background:
The aim of this study was to identify predictors of repeated admission to the intensive care unit (ICU) of patients who underwent cardiac surgery procedures.
Material/Methods:
This retrospective study analyzed 169 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2009 and December 2010. The case group contained 54 patients who were readmitted to the ICU during the same hospitalization and the control group comprised 115 randomly selected patients.
Results:
Logistic regression analysis revealed that independent predictors for readmission to the ICU after CABG were: older age of patients (odds ratio [OR] 1.04; CI 1.004-1.08); body mass index (BMI)>30 kg/m2 (OR 2.55; CI 1.31-4.97); EuroSCORE II>3.9% (OR 3.56; CI 1.59-7.98); non-elective surgery (OR 2.85; CI 1.37-5.95); duration of operation>4 h (OR 3.44; CI 1.54-7.69); bypass time>103 min (OR 2.5; CI 1.37-4.57); mechanical ventilation>530 min (OR 3.98; CI 1.82-8.7); and postoperative central nervous system (CNS) disorders (OR 3.95; CI 1.44-10.85). The hospital mortality of patients who were readmitted to the ICU was significantly higher compared to the patients who did not require readmission (17% vs. 3.8%, p=0.025).
Conclusions:
Identification of patients at risk of ICU readmission should focus on older patients, those who have higher BMI, who underwent non-elective surgery, whose operation time was more than 4 hours, and who have postoperative CNS disorders. Careful optimization of these high-risk patients and caution before discharging them from the ICU may help reduce the rate of ICU readmission, mortality, length of stay, and cost.
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