Prolonged intensive care unit stay after coronary artery bypass graft surgery: Role of perioperative factors
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Published on: March 27, 2018
Babatunde Babasola Osinaike1, Babatunde Okikiolu, Oluyemisi Olusesin
1From the Department of Anaesthesia, University College Hospital; Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Insights
Left ventricular support with inotropes is the sole independent predictor of prolonged Intensive Care Unit (ICU) stays following coronary artery bypass graft (CABG) surgery. Optimizing perioperative care to minimize the need for such support is crucial for improving patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Intensive Care Medicine
Background:
- Prolonged Intensive Care Unit (ICU) stays after coronary artery bypass graft (CABG) surgery are associated with increased mortality, poor prognosis, and high costs.
- Identifying perioperative predictors of extended ICU admission is essential for optimizing patient management and resource allocation.
Purpose of the Study:
- To determine perioperative factors significantly predicting prolonged ICU admission after CABG surgery.
- To identify independent predictors of extended ICU stay in patients undergoing elective CABG.
Main Methods:
- Retrospective study of 194 patients undergoing elective CABG surgery between November 2008 and January 2009.
- Data collected included patient demographics, comorbidities, pre-operative left ventricular (LV) function, bypass duration, cardiovascular support, and re-exploration.
- Prolonged ICU admission was defined as a stay exceeding 4 days.
Main Results:
- Univariate analysis indicated significant differences in pulmonary hypertension, bypass time, LV support, and re-exploration between patients with short versus prolonged ICU stays.
- Multiple regression analysis identified left ventricular (LV) support with inotropes as the only independent predictor of prolonged ICU stay (β = 0.69; P = 0.003).
Conclusions:
- Left ventricular (LV) support with inotropes is the sole independent predictor of prolonged ICU stay after CABG surgery.
- Focusing on excellent perioperative care to reduce the need for LV support post-cardiopulmonary bypass is a key goal for improving outcomes.
Introduction:
Long stay in the Intensive Care Unit (ICU) after coronary artery bypass graft (CABG) surgery has been found to result in increased hospital mortality, poor long-term prognosis, prolonged hospital stay, and consequently, high cost and expenses. We, therefore, reviewed CABG surgery performed at the Madras Medical Mission Chennai, India, during a 3-month period to determine perioperative factors that are significant predictors of prolonged ICU admission.
Methods:
We retrospectively studied patients who had elective CABG surgery from November 2008 to January 2009. Information about the following perioperative variables were retrieved; patient demographics, history of co-morbid disease, pre-operative left ventricular (LV) function, the number of coronary vessels grafted, duration of bypass, the level of cardiovascular support post-bypass, the need for surgical re-exploration and duration of stay in the ICU. Prolonged ICU admission was defined as stay over 4 days after elective CABG surgery.
Results:
A total of 194 patients were reviewed, with males accounting for 84%, age ranged from 32 to 80 years, and duration of stay in the ICU from 2 to 14 days, with mean values of 58.06 ± 8.48 years and 3.96 ± 1.60 days, respectively. Univariate analysis showed significant differences in the number of patients with pulmonary hypertension (P = 0.002), mean bypass time (P = 0.018), requirement for LV support with inotrope (P = 0.021) and surgical re-exploration (P = 0.016) when patients with ICU stay ≤4 days were compared to those with stay over 4 days. Multiple regression revealed only LV support (β =0.69; P = 0.003) as the independent predictor of prolonged ICU stay.
Conclusion:
This review showed LV support with inotrope as the only independent predictor of prolonged ICU stay after CABG surgery. Therefore, an excellent perioperative care leading to a reduced requirement for LV support after cardiopulmonary bypass for CABG surgery should be the goal.
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