Twenty-four-hour continuous attending coverage in a dedicated cardiovascular intensive care unit decreases mortality...

The effect of continuous in-house attending coverage in a dedicated cardiovascular intensive care unit (CVICU) on postoperative cardiac surgery outcomes remains incompletely defined. This study evaluated morbidity and mortality data immediately before and after implementation of a 24/7 in-house critical care attending coverage model, in a dedicated CVICU, using the Society of Thoracic Surgeons risk-adjusted data for coronary artery bypass grafting and valvular repair/replacement surgeries.

Four hundred nineteen patients underwent coronary artery bypass grafting, and/or a mitral valve repair or replacement, and/or an aortic valve replacement at a single institution between April 2022 and 2024. From April 2022 to April 2023 patients recovered in a general surgical intensive care unit, with daytime attending critical care coverage and nighttime resident coverage with attending home call. From April 2023 to April 2024, patients recovered in a dedicated CVICU with continuous in-house, intensivist attending and resident coverage. Society of Thoracic Surgeons risk-adjusted outcomes were compared using exact Poisson and Fisher exact tests.

Despite greater predicted mortality in the postintervention period, observed mortality was significantly reduced (0.46% vs 3.94%, P = .017), with a lower observed-to-expected ratio (P = .007). No significant differences were found in secondary outcomes: renal failure, prolonged ventilation, and long length of stay (P = .97, P = .47, and P = .94, respectively).

A dedicated CVICU with 24/7 in-house critical care attending coverage significantly reduced mortality as compared with resident-driven, lower-intensity intensive care unit model. This coverage change did not appear to influence renal failure, prolonged mechanical ventilation, or length of hospital stay.