Predictors of Prolonged ICU Stay After Isolated CABG: The Role of MiECC
Alper Özbakkaloğlu1, Ömer Faruk Rahman1, Mert Arslangilay1
1Department of Cardiovascular Surgery, İzmir Bakırçay University, Menemen 35665, Turkey.
Insights
Lower preoperative ejection fraction and higher leukocyte counts predict prolonged intensive care unit (ICU) stays after coronary artery bypass grafting (CABG). Minimally invasive extracorporeal circulation (MiECC) did not impact ICU duration in this study.
Area of Science:
- Cardiology
- Cardiac Surgery
- Intensive Care Medicine
Background:
- Prolonged intensive care unit (ICU) stays after coronary artery bypass grafting (CABG) present a significant clinical challenge.
- Identifying predictive factors for extended ICU stays is crucial for optimizing patient management and resource allocation.
Purpose of the Study:
- To identify preoperative and intraoperative factors predicting prolonged ICU stay in isolated CABG patients.
- To evaluate the impact of minimally invasive extracorporeal circulation (MiECC) on ICU stay duration.
Main Methods:
- Retrospective analysis of 82 patients undergoing isolated CABG.
- Definition of prolonged ICU stay as >72 hours.
- Logistic regression and ROC curve analyses to identify predictors.
Main Results:
- Lower preoperative left ventricular ejection fraction (LVEF) and higher preoperative leukocyte counts were independent predictors of prolonged ICU stay.
- MiECC utilization showed no independent association with prolonged ICU stay.
- The prolonged ICU stay group had significantly lower LVEF and higher leukocyte counts.
Conclusions:
- Preoperative cardiac function (LVEF) and inflammatory status (leukocyte count) are key predictors of prolonged ICU stay post-CABG.
- MiECC does not appear to independently influence ICU stay duration.
- Further prospective research is needed to confirm these findings and guide clinical practice.
Abstract:
Background and Objectives: Prolonged intensive care unit (ICU) stay following coronary artery bypass grafting (CABG) remains a major clinical challenge. The aim of this study was to identify preoperative and intraoperative factors that may predict prolonged ICU requirement in patients undergoing isolated CABG and to evaluate the impact of minimally invasive extracorporeal circulation (MiECC) utilization on this outcome. Materials and Methods: Patients who underwent isolated CABG between January 2024 and April 2025 were retrospectively analyzed. Prolonged ICU stay was defined as a postoperative intensive care duration exceeding 72 h. Predictors of prolonged ICU stay were evaluated using univariate logistic regression and four multivariable logistic regression models. Receiver operating characteristic (ROC) curve analyses were performed to assess the discriminative performance of significant and clinically relevant variables as well as the multivariable models. Results: A total of 82 patients were included and stratified into a prolonged ICU stay group (n = 32) and a non-prolonged ICU stay group (n = 50). The preoperative left ventricular ejection fraction (LVEF) was significantly lower (52.5% vs. 60%, p = 0.012) and preoperative leukocyte counts significantly elevated (8.4 vs. 7.97 × 103/µL, p = 0.049) in the prolonged stay group. MiECC was employed in 28.1% of patients with a prolonged ICU stay and 30% of those with a non-prolonged stay (p = 0.530). Across four multivariable logistic regression models, lower preoperative ejection fraction and higher preoperative leukocyte count were identified as independent predictors of prolonged ICU stay, whereas MiECC utilization was not independently associated with this outcome. Conclusions: Lower preoperative ejection fraction and higher baseline leukocyte count were independently associated with prolonged ICU stay. No independent association between MiECC utilization and prolonged ICU stay could be demonstrated. These findings suggest that preoperative cardiac function and inflammatory status may contribute to ICU requirements following isolated CABG. Further prospective studies are warranted to validate these findings.
