Risk factors associated with longer stays in cardiovascular surgical intensive care unit after CABG

Area of Science:

• Cardiovascular Surgery
• Intensive Care Medicine
• Health Services Research

Background:

• Effective monitoring of Intensive Care Unit (ICU) length of stay (LOS) after Coronary Artery Bypass Grafting (CABG) is essential for care improvement initiatives.
• Few studies have comprehensively evaluated personal, clinical, and ICU care demands as risk factors for prolonged ICU LOS post-CABG.

Purpose of the Study:

• To apply the Donabedian model to identify risk factors associated with extended ICU stays following CABG.
• To investigate lifestyle, intraoperative/postoperative clinical factors, and demands of ICU care (TISS) as structure factors.
• To examine infection and organ failures during ICU stay as process factors.

Main Methods:

• A retrospective cohort study utilizing medical records from a single medical center.
• A stratified randomized sample of 230 adult patients from a cohort of 690 isolated CABG procedures.
• Sample stratified to reflect a 34.7% rate of ICU LOS exceeding 3 days, with 150 in the longer-stay group and 80 in the shorter-stay group.

Main Results:

• Hierarchical logistic regression identified potential infection signs (WBC > 10,000/μL, OR: 3.41; Temp > 38°C, OR: 5.67) and acute renal failure (OR: 8.97) as significant predictors of prolonged ICU stay (>3 days).
• Higher TISS score within 24 hours (OR: 1.06), female gender (OR: 4.16), smoking (OR: 4.87), higher pre-surgery Charlson Comorbidity Index (CCI) (OR: 1.49), and undergoing bypass during CABG (OR: 3.51) were also associated with increased risk of longer ICU stay.

Conclusions:

• Quality improvement initiatives to reduce ICU LOS post-CABG should focus on promoting smoking cessation programs.
• Enhanced management strategies for infection control and renal failure are critical.
• Optimizing manpower allocation within the ICU setting is also recommended to shorten patient stays.