Predictors of Prolonged Intensive Care Unit Stay After Heart Valve Surgery: A Case-Control Study

Prolonged intensive care unit (ICU) stay after heart valve surgery may delay recovery and increase complications; however, the risk factors remain underexplored.

In this study, we aimed to identify pre-, intra-, and postoperative clinical factors associated with prolonged ICU stay after heart valve surgery.

A retrospective case-control analysis was conducted on 498 patients admitted to the cardiovascular surgical ICU of a tertiary hospital in Seoul from January 1, 2021, to December 31, 2022. Patients were grouped based on ICU length of stay: ≤72 hours (nonprolonged, n = 332) and >72 hours (prolonged, n = 166), matched by age, sex, and surgery date. Data were obtained from the electronic medical records. Statistical analyses included t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and logistic regression.

Significant predictors of prolonged ICU stay included New York Heart Association class (NYHA) II (odds ratio [ OR ] = 3.33, 95% confidence interval [CI] = 1.79-6.18), higher EuroSCORE II ( OR = 1.29, 95% CI = 1.10-1.53), fluid imbalance ( OR = 1.27, 95% CI = 1.01-1.59), and longer intubation duration ( OR = 1.01, 95% CI = 1.01-1.02). Additional factors included postoperative arrhythmia, red blood cell transfusion, neurological complications, hemodialysis, and fever.

Multiple clinical and postoperative factors were associated with a prolonged ICU stay after valve surgery. These findings can inform nursing protocols and targeted interventions to enhance recovery and reduce ICU burden.