Determinants of prolonged length of hospital stay after coronary bypass surgery.

Weintraub, William S.; Jones, Ellis L.; Craver, Joseph M.; Guyton, Robert A.; Cohen, Caryn L.

doi:10.1161/01.cir.80.2.276

Cited by 138 publications

(55 citation statements)

References 14 publications

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“…Thus, the combination of diabetes with some of these variables can justify its expression as a risk factor. Our observations related to diabetes were similar to other studies that have shown a higher proportion of diabetics in the group with prolonged hospitalization [9,16,18,21], and that this disorder, itself, is a risk factor for prolonged hospitalization [11,13]. However, other studies found no association between diabetes and risk for prolonged hospitalization [6,7,16].…”

Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatsupporting

confidence: 91%

“…About cutoff for prolonged hospitalization, established by the 70 th percentile of the sample, similar to other studies [8,14,16], we should consider that some authors justify a clinical arbitrary choice [10,17]. Bucerius et al [11] justified that these times of hospitalization included almost all patients with postoperative complications able to prolong the intensive treatment.…”

Section: Discussionmentioning

confidence: 68%

“…Another important issue is that some studies include, in the same sample, patients undergoing other cardiac surgery associated with CABG [7,8,15]. The heterogeneity of the samples in the use of CPB [6,9] and diversity as the cutoff for prolonged hospitalization, rangesfrom 2 to 10 days in the ICU [7,9] and 7-14 days of the total time in the postoperative period [13,16].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Oliveira¹,

Turquetto²,

Tauil³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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353Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):353- ORIGINAL ARTICLE Abstract Introduction: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality.Objective: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards.Methods: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P ≤0.05 was considered statistically significant.Results: Hospital stay >3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction <50% (OR=3.04). Combining pre-and intraoperative factors, diabetes (OR=2.81), and including postoperative factors, presence of infection (OR=4.54) were predictors of prolonged hospitalization in the ward.Conclusion: Diabetes and smoking were predictors of intensive care unit outcome, and ejection fraction <50% of ward outcome. For the set of perioperative factors, prolonged hospitalization after isolated coronary artery bypass grafting was associated with mechanical ventilation >24 hours for the intensive care unit and presence of infection for the ward.Descriptors: Risk factors. Myocardial revascularization. Hospitalization. ResumoIntrodução: Características do paciente e da cirurgia de revascularização do miocárdio podem predispor à internação prolongada, aumentando custos e a morbimortalidade.Objetivo: Avaliar fatores de risco individuais e transoperató-rios para internação prolongada na unidade de terapia intensiva e na enfermaria. 354Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(3):353-63 Oliveira EK, et al. -Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting productivity [4,8], affecting family budgets, quality of life and increasing costs [1]. Bashour et al. [7] showed that, after cardiac surgery, many patients with prolonged hospital stay died soon after discharge and that the functional status of those who survived for a longer period was worse when compared with those who recovered faster. RevIn this context, the objective of this study was to identify pre-, intra-and postoperative risk factors for long hospitalizations in the ICU or the ward, of patients undergoing isolated CABG surgery w...

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Section: Bmi -Body Mass Index; Ef -Ejection Fraction; Oi-sc -Oxygenatsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Oliveira¹,

Turquetto²,

Tauil³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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“…Study on revision spinal surgeries (9) documented that more levels fused, female gender, unemployment and history of diabetes mellitus would increase hospital LOS. Similar reports in other kinds of surgeries demonstrated that increasing age, female gender, low socioeconomic status and much more comorbidities could increase the duration of hospital stay (16)(17)(18)(19)(20). Linear regression analysis results showed that age > 50 years, volume of intraoperative blood loss (especially more than 500 mL), operation length (particularly more than 180 minutes), increased levels of fused (mainly more than three levels) and the number of comorbid conditions could predict increased hospital LOS.…”

Section: Discussionsupporting

confidence: 54%

Predictive Factors of Blood Loss and Hospital Stay in Patients With Major Lumbosacral Surgeries: A Multi-Center, Prospective, Cross-Sectional Survey

Miri¹,

Farzanegan²,

Khosravi³

et al. 2015

Arch Neurosci

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Background: Blood loss during spinal decompression and fusion is high and at times more than the patient's total estimated blood. Increased blood loss may increase the risks of morbidity and eventually length of hospital stay (LOS). Objectives: The aim of this study was to identify predictor factors of blood transfusion requirements and the length of hospital stay in adult patients who underwent lumbosacral surgery. Materials and Methods:This was a multicenter cross-sectional study to predict factors of hospital length of stay (LOS) and intraoperative red cell transfusion in patients undergoing major posterior lumbar spinal surgeries. In this study, 298 patients who needed spinal surgery were enrolled. Results: Multiple linear regression results revealed the following information. Among variables that had significant association with the volume of intraoperative blood loss, considerable predictors were the number of level fused (R 2 = 0.42), mean intraoperative SBP (R 2 = 0.22), length of operation (R 2 = 0.31) and increasing age (R 2 = 0.37). Significant predictors for the length of hospital stay were increasing age (R 2 = 0.22), much more comorbid conditions (R 2 = 0.30), operation length (R 2 = 0.27), the number of level fused (R 2 = 0.21) and the volume of intraoperative blood loss (R 2 = O.29). The results of logistic regression revealed that length of operation, preoperative Hb value, number of level fused and mean intraoperative SBP considerably predicted the need for intraoperative blood transfusion. Conclusions: Diminishing intraoperative SBP could decrease intraoperative blood loss and eventually less red cell transfusion and shorter LOS. Besides, correcting preoperative anemia in female patients before elective surgeries could decrease a need for red cell transfusions and ultimately decreased red cell transfusion complication rate and shorter hospital LOS.

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“…The origins of this problem are multifactorial and include ischemia-reperfusion injury (IRI). [1][2][3][4][5][6][7] Interest has focused on the potential of anesthetics to protect the heart and lung against IRI, due to their ability to modify oxidant mediated cell injury, s,9 Recently, the intravenous anesthetic, 2,6-diisopropylphenol, propofol, has been shown to have antioxidant properties, l~ Experimental evidence suggests propofol may protect the myocardium and lung against peroxide and peroxynitrite) 2,1s However, a recent study did not provide clinical evidence of protection with propofol anesthesia used for cardiac procedures. I4 The dose of propofol administered (50 to 100 lag.kg-l.min -1) was limited by the concern that propofol may produce hypotension secondary to cardiac depression and vasodilatation.…”

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confidence: 99%

High dose propofol enhances red cell antioxidant capacity during CPB in humans

Ansley

Sun

Visser

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: To compare low vs high dose propofol and isoflurane on red cell RBC antioxidant capacity in patients during aortocoronary bypass surgery (ACBP). Methods: Twenty-one patients, for ACBP, were anesthetized with sufentanil 0.5-10 ~ug.kg -I and isoflurane 0-2%; ISO = control; n=7), or sufentanil 0.3/./g'kg -t, propofol I-2.5 mg-kg -I bolus then 100/./g-kg-l-min -I before, and 50/Jg'kg-I'min -I during CPB (LO; n=7 ), or sufentanil 0.3/Jg'kg -I, propofol 2-2.5 mg-kg -t bolus then 200 /Jg.kg -I .min -I (HI; n=7 ). Venous blood was drawn pre-and post-induction, after 30 min CPB, 5, 10, and 30 min of reperfusion, and 120 min post-CPB to measure red cell antioxidant capacity (malondialdehyde (NDA) production in response to oxidative challenge with t-butyl hydrogen peroxide) and plasma propofol concentration. Pre-induction blood samples were analyzed for antioxidant effects of nitrates on red cells. The tBHP concentration response curves for RBC MDA in ISO, LO and HI were determined. Results: Preoperative nitrate therapy did not effect RBC MDA production. Perioperative RBC MDA production was similar in ISO and LO groups. Sustained intraoperative decrease in RBC IDA was seen with propofol 8.0 + 2.4 -I 1.8 ___ 4.5 g/g.ml "l in HI (P < 0.05-0.0001). MDA production vs log plasma propofol concentration was linear in HI dose. Conclusions: During CPB, RBC antioxidant capacity is enhanced and maintained with HI dose propofol. Propofol, at this dose, may prove useful in protecting against cardiopulmonary ischemia-reperfusion injury associated with ACBP.Objc~df : Comparer une faible dose (LO) vs une forte dose (HI) de propofol et d'isoflurane sur la capacit~ antioxydante des globules rouges (OR) lots d'un pontage aortocoronarien (PAC). M~thodc : Lots d'un PAC, 21 patients ont re~u une anesth&ie avec du sufentanil 0,5-I 0 Alg'l,,g -~ et de risoflurane 0-2 %; (ISO = t~moin, n = 7) ou du sufentanil 0,3 A/g-kg -I, un bolus de propofol I-2,5 mg.kg-lsuivi d'une perfusion de 100/.Ig'kg -I'min -I avant le PAC et de 50/~g'l,,g -I'min -I pendant le PAC (LO, n = 7 ), ou du sufentanil 0,3/Jg.kg -I , un bolus de propofol 2-2,5 mg'kg -I et une perfusion de 200 A/g-kg -I.min -I (HI, n = 7 ). Le sang veineux a ~t~ pr~lev~ avant et apr& I'induction, 30 rain apr~s le PAC, ~ 5, I 0 et 30 min pendant la repeffusion et 120 min apr~s la CEC afin de mesurer la capacit~ antioxydante des GR (production de diald~hyde malonique DAN en r~ponse ~ la provocation oxydante avec du peroxyde d'hydrog~ne t-butyl PHtB) et la concentration plasmatique de propofol. Les &hantillons de sang pr~lev6s avant I'induction ont &~ analys& pour v~dfler les effets antioxydants des nitrates sur les GR. Les courbes illustrant la r~action des GR au DAM chez les patients des groupes ISO, LO et Ht ont &~ d~termin~es. l~t~ts : La th~rapie pr~op6ratoire aux nitrates n'a pas chang~ la capacit?~ antioxydante des GR, donc la production de DAM a ~t~ semblable dans les groupes ISO et LO. Une baisse perop~ratoire de production de DAM atoutelois ~t~ observ& avec 8,0 ___ 2,4 -11,8 -+ 4.5...

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Determinants of prolonged length of hospital stay after coronary bypass surgery.

Cited by 138 publications

References 14 publications

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Predictive Factors of Blood Loss and Hospital Stay in Patients With Major Lumbosacral Surgeries: A Multi-Center, Prospective, Cross-Sectional Survey

High dose propofol enhances red cell antioxidant capacity during CPB in humans

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