Long-Term Outcome and Predictors of Noninstitutionalized Survival Subsequent to Prolonged Intensive Care Unit Stay After Cardiac Surgical Procedures

Abstract

The majority of patients who had a prICULOS experienced successful functional survival up to 5 years after cardiac operations. Identification of risk factors for poor functional survival may be of assistance to clinicians, patients, and families for prognostication and decision making.

Early Rehospitalization After Prolonged Intensive Care Unit Stay Post Cardiac Surgery: Outcomes and Modifiable Risk Factors

“…Secondly, the probability that the high rehospitalization rate was secondary to early discharge from the hospital was low. From our previous analysis, our hospital length of stay after the index operation was a median of 24.0 days, with 14.3% needing transfer to a community hospital requiring an additional 21.5 days median stay for prICULOS patients. The equivalent numbers for non‐prICULOS patients was 8.0 days median hospital LOS, where 4.2% of them were transferred for further care of 12.0 days (median).…”

“…Importantly, that was associated with almost a quadrupling of risk in non‐prICULOS patients, the etiology of which needs further investigation. Furthermore, at present, about 10% of patients need prICULOS after cardiac surgery but this number is over 50% higher than a decade ago . With high rehospitalization rates and an expected increasing number of cardiac surgery patients expected to have prICULOS over the next decades, it is likely that there will be significant economic implications for policy makers, healthcare systems, and society.…”

“…The Manitoba Centre for Health Policy at the University of Manitoba's Faculty of Medicine in Winnipeg, Manitoba, Canada, houses several provincial clinical and administrative databases within the Population Health Research Data Repository. The clinical data for this study were from the Winnipeg Regional Health Authority ICU database and the Manitoba Cardiac Surgical Database as previously published . Separation Abstracts data provided information about an individual's initial cardiac surgery hospitalization and any subsequent rehospitalization.…”

“…Specifics of definitions used are provided in Data . The databases have been validated and used in a number of studies …”

“…Complex cardiac surgical procedures are increasingly being offered to older adult patients with more comorbidities, resulting in an increasing proportion of patients needing prolonged intensive care unit length of stay (prICULOS) . A recent study demonstrated a 57% increase in the number of patients needing prICULOS over a decade where the “functional survival” of these patients, defined as alive and not institutionalized, was 74% at 1 year . It is known from the noncardiac surgery ICU literature that the 30‐day and 1‐year post ICU discharge hospital readmission rates (not necessarily with prICULOS) are high at 16% and 41%, respectively .…”