ICU readmission after cardiac surgery

• Published in: European journal of cardio-thoracic surgery Vol. 23; no. 3; pp. 354 - 359
• Main Authors: Bardell, T., Legare, J.F., Buth, K.J., Hirsch, G.M., Ali, I.S.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.03.2003; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Cardiac surgery; Coronary Artery Bypass; Female; Hospital Mortality; Humans; Intensive care unit; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Logistic Models; Male; Medical sciences; Middle Aged; Nova Scotia; Odds Ratio; Patient Readmission - statistics & numerical data; Postoperative Complications - therapy; Readmission; Respiration, Artificial; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Time Factors; Nova Scotia; Readmission; Intensive care unit; Cardiac surgery; Human; Prognosis; Mortality; Risk analysis; Morbidity; Aortocoronary; Bypass; Surgery; Risk factor; Graft
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/s1010-7940(02)00767-4

Objectives: The increasing cost of intensive care unit (ICU) care and limited resources lead us to evaluate predictors of ICU readmission in a large group of patients undergoing coronary artery bypass surgery (CABG) at one institution. Methods: Two thousand one hundred and seventeen consecutive patients undergoing CABG surgery between January 1999 and August 2001 were reviewed retrospectively. The reasons for readmission were determined by reviewing the physician's progress notes, the nurse's progress notes and the discharge summary. Results: A total of 75 patients were readmitted to ICU during the study period for a readmission rate of 3.6%. Eight of these were readmitted a second time, and three a third time, for a total of 86 readmissions. Forty-seven patients died, for a mortality of 2% among patients that were not readmitted to the ICU, compared to 17% among those who were readmitted (P<0.0001). Median hospital length of stay was 6 days for patients not readmitted and 23 days for those readmitted (P<0.0001). The most common reason for readmission was respiratory failure, accounting for 47% of readmissions (n=40). Multivariate analysis using a stepwise logistic regression analysis revealed that preoperative renal failure (odds ratio 2.13; CI 1.03–4.41) and prolonged mechanical ventilation of >24 h (odds ratio 10.52; CI 6.18–17.91) were the only independent predictors for readmission to the ICU after CABG. Conclusions: Identification of patients that have preoperative renal failure or that required initial ventilation for more than 24 h after CABG may help to identify patients at risk of ICU readmission. Preemptive strategies designed to optimize these high-risk patients may improve outcomes.