Risk factors of prolonged intensive care unit stay following cardiac surgery for infective endocarditis

Area of Science:

• Cardiology
• Cardiac Surgery
• Infective Endocarditis
• Intensive Care Medicine

Background:

• Prolonged intensive care unit (ICU) stays are common in patients undergoing cardiac surgery, particularly those with infective endocarditis (IE).
• Extended ICU stays are linked to increased mortality and poorer patient prognosis.
• This study aimed to identify risk factors for prolonged ICU stays post-cardiac surgery for IE to mitigate operative risks.

Purpose of the Study:

• To determine the key risk factors associated with prolonged intensive care unit (ICU) stay after cardiac surgery for infective endocarditis (IE).
• To provide insights for optimizing patient management and reducing adverse outcomes in this high-risk population.

Main Methods:

• A retrospective analysis was conducted on 896 patients who underwent cardiac surgery for IE between January 2006 and November 2022.
• Patients were categorized into two groups: ICU stay ≤3 days and ICU stay >3 days.
• Univariable and multivariable analyses were employed to identify associated factors.

Main Results:

• Of the 896 patients, 48 (5.4%) experienced operative death. Prolonged ICU stay was associated with male gender, advanced age, higher weight, longer vegetation length, paravalvular leak, and extended aortic cross-clamp and cardiopulmonary bypass (CPB) times.
• Other significant factors included longer mechanical ventilation, increased postoperative hospitalization, elevated serum creatinine levels (pre- and post-surgery), positive fluid balance on the operation day, and postoperative acute kidney injury.
• Preoperative aortic insufficiency, left ventricular end-diastolic dimension (LVEDD), chest drainage, and transfusion of frozen plasma and packed red cells were also identified as risk factors.

Conclusions:

• Shortening ICU stay through optimization of pre-, peri-, and postoperative factors is essential for improving patient outcomes.
• Addressing identified risk factors can lead to reduced mortality and morbidity rates in patients undergoing cardiac surgery for IE.