Effect of centre-, patient- and procedure-related factors on intensive care resource utilisation after cardiac surgery

Abstract

In European ICUs resource utilisation is highly variable after cardiac surgery. Up to two thirds more patients could be treated with current ICU resources if the most efficient strategies and structures were applied across all centres.

Variability in outcome and resource use in intensive care units

“…As a consequence there is a need for an extended analysis of the link between ICU structures and the process of care, on the one hand, and resource use and outcome, on the other. In general it is thought that there is marked variability between individual intensive care units (ICUs), both with respect to outcome and with respect to resource use [2,3]. However, only limited information exists about factors influencing such variability [4,5].…”

Duration of preceding hypertension is associated with prolonged length of ICU stay

“…However, such differences make direct study comparisons difficult [9]. Finally, the impact of institutional characteristics and type of ICU organization on length of stay must also be taken into account [11,12].…”

“…Additionally, differences in patient populations ('all cardiac surgical' or 'just 'CABG', and between-cohort patient demographics) and institutional characteristics and policies [11,12] make the comparability of studies difficult [9]. Nonetheless, identifying those factors associated with PLOS and PMV would be advantageous in assisting in the organisation of patient flow and in individual risk stratification, whilst offering the potential to mitigate such risk.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].0), by 12.9% (95% CI 7.6 v 18.5, p b 0.0001) and by 21.8% (95% CI 14.6-29.4) from pre-surgery (100.2) to post-operative day 1 (110.1), day 2 (112.2) and day 3 (134.9), respectively (all p b 0.0001). This increase was significantly greater in those with both PLOS and PMV than either outcome individually (day 1 26.4% v 5.0% v 5.1%, p b 0.001; day 2 40.7% v 8.6% v −1.7%, p b 0.001; day 3 40.0% v 15.1% v 0.0%, p b 0.001) with the change in creatinine level from pre-surgery to post-operative day 2 being significantly greater in patients with pre-operative hypertension than those without (20.0% v 7.4%, p = 0.02).…”

Importance of Extubation Stress following Off-pump CABG

“…The classical coronary bypass surgery performed with the heart stopped and using heart-lung machine is called as on-pump CABG, whereas the coronary bypass surgery performed without stopping the heart or using heart-lung machine is called as off-pump CABG [1]. Traditional approach for the anesthesia for cardiac surgery includes high-dose opioid use and long-acting muscle relaxants.…”