Predicting Readmission to Intensive Care After Cardiac Surgery Within Index Hospitalization: A Systematic Review

Kimani, Linda; Howitt, Samuel H.; Tennyson, Charlene; Templeton, R. D.; McCollum, Charles; Grant, Stuart W

doi:10.1053/j.jvca.2021.02.056

Cited by 4 publications

(13 citation statements)

References 46 publications

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“…The incidence of ICU readmission in cardiac surgical patients within the course of the index hospitalization ranges from 2 to 8% based on the existing relevant literature. 4 5 6 7 8 9 10 11 12 13 14 15 ICU readmission entails a protracted length of stay in the hospital and consequent unfavorable clinical outcomes. The in-hospital mortality rates are to the remarkable tune of 11 to 24% for the readmitted patient cohort.…”

Section: Readmission As An Event Is “ Far From Benign”mentioning

confidence: 99%

“…Moreover, the resultant strain imposed on the health care system can also not be ignored, particularly in the context of an increased cost and resource burden on the already constrained ecosystem of the low- and middle-income countries. 4 5 7 8 9 10 11 12 13 14 15 Bettex and Rudiger adequately elaborate the negative impact of readmission not only on the health system but the family of the patient as well. 7…”

Section: Readmission As An Event Is “ Far From Benign”mentioning

confidence: 99%

“…The causes for ICU readmission in cardiac surgical subset outlined by the various independent research groups have been summarized in Table 1 . 4 5 6 7 8 9 10 11 12 13 14 15 The majority of the ICU readmissions result owing to the underlying respiratory and cardiac reasons. Postoperative pneumonia (hospital-acquired/aspiration), pleural–effusion, poor ventilatory reserve, etc., leading to hypoxemia and respiratory failure necessitating reintubation and mechanical ventilation, account for the major cause of readmission.…”

Section: Icu Readmission: Causes and Risk Factorsmentioning

confidence: 99%

“…13 The need for reoperative interventions, sepsis, and other morbid organ outcomes also contributes to the overall ICU readmission burden ( Table 1 ). 4 5 6 7 8 9 10 11 12 13 14 15…”

Section: Icu Readmission: Causes and Risk Factorsmentioning

confidence: 99%

“…1 2 3 As we embrace the ever-growing opportunities to fast-track following cardiac surgery, there is a concurrent need to holistically assess the research landscape of a closely related and equally (if, not more) important phenomenon of intensive care unit (ICU) readmission in cardiac surgical subset following a primary discharge. 4 5 6 7 8 9 10 11 12 13 14 15…”

Section: Introductionmentioning

confidence: 99%

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ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering

Kalaiselvan

Kashav

Kohli

et al. 2022

Journal of Cardiac Critical Care TSS

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Over the past decades, there have been noteworthy advancements in the cardiac surgical practice that have assisted fast-tracking and enhanced recovery after cardiac surgery (ERACS). With that said, intensive care unit (ICU) readmission in this high-risk patient cohort entails a significant morbidity–mortality burden. As an extension of the same, there has been a heightened emphasis on a comprehensive evaluation of the predisposition to readmission following a primary ICU discharge. However, the variability of the institutional perioperative practices and the research complexities compound our understanding of this heterogeneous outcome of readmission, which is intricately linked to both patient and organizational factors. Moreover, a discussion on ICU readmission in the recent times can only be rendered comprehensive when staged in close conjunction to the fast-tracking practices in cardiac surgery. From a more positive probing of the matter, a preventative outlook can likely mitigate a part of the larger problem of ICU readmission. Herein, focused cardiac prehabilitation programs can play a potential role given the emerging literature on the positive impact of the former on the most relevant readmission causes. Therefore, the index review article aims to address the subject of cardiac surgical ICU readmission, highlighting the magnitude and burden, the causes and risk-factors, and the research complexities alongside deliberating the topic in the present-day context of ERACS and cardiac prehabilitation.

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Section: Readmission As An Event Is “ Far From Benign”mentioning

confidence: 99%

Section: Readmission As An Event Is “ Far From Benign”mentioning

confidence: 99%

Section: Icu Readmission: Causes and Risk Factorsmentioning

confidence: 99%

“…13 The need for reoperative interventions, sepsis, and other morbid organ outcomes also contributes to the overall ICU readmission burden ( Table 1 ). 4 5 6 7 8 9 10 11 12 13 14 15…”

Section: Icu Readmission: Causes and Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering

Kalaiselvan

Kashav

Kohli

et al. 2022

Journal of Cardiac Critical Care TSS

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First initiation of mobilization out of bed after cardiac surgery – an observational cross-sectional study in Sweden

Westerdahl,

Lilliecrona,

Sehlin

et al. 2024

J Cardiothorac Surg

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Background Cardiac surgery is associated with a period of postoperative bed rest. Although early mobilization is a vital component of postoperative care, for preventing complications and enhancing physical recovery, there is limited data on routine practices and optimal strategies for early mobilization after cardiac surgery. The aim of the study was to define the timing for the first initiation of out of bed mobilization after cardiac surgery and to describe the type of mobilization performed. Methods In this observational study, the first mobilization out of bed was studied in a subset of adult cardiac surgery patients (n = 290) from five of the eight university hospitals performing cardiothoracic surgery in Sweden. Over a five-week period, patients were evaluated for mobilization routines within the initial 24 h after cardiac surgery. Data on the timing of the first mobilization after the end of surgery, as well as the duration and type of mobilization, were documented. Additionally, information on patient characteristics, anesthesia, and surgery was collected. Results A total of 277 patients (96%) were mobilized out of bed within the first 24 h, and 39% of these patients were mobilized within 6 h after surgery. The time to first mobilization after the end of surgery was 8.7 ± 5.5 h; median of 7.1 [4.5–13.1] hours, with no significant differences between coronary artery bypass grafting, valve surgery, aortic surgery or other procedures (p = 0.156). First mobilization session lasted 20 ± 41 min with median of 10 [1–11]. Various kinds of first-time mobilization, including sitting on the edge of the bed, standing, and sitting in a chair, were revealed. A moderate association was found between longer intubation time and later first mobilization (ρ = 0.487, p < 0.001). Additionally, there was a moderate correlation between the first timing of mobilization duration of the first mobilization session (ρ = 0.315, p < 0.001). Conclusions This study demonstrates a median time to first mobilization out of bed of 7 h after cardiac surgery. A moderate correlation was observed between earlier timing of mobilization and shorter duration of the mobilization session. Future research should explore reasons for delayed mobilization and investigate whether earlier mobilization correlates with clinical benefits. Trial registration FoU in VGR (Id 275,357) and Clinical Trials (NCT04729634).

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Improving Intensive Care Unit Early Readmission Prediction Using Optimized and Explainable Machine Learning

González-Nóvoa

Campanioni

Busto

et al. 2023

IJERPH

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It is of great interest to develop and introduce new techniques to automatically and efficiently analyze the enormous amount of data generated in today’s hospitals, using state-of-the-art artificial intelligence methods. Patients readmitted to the ICU in the same hospital stay have a higher risk of mortality, morbidity, longer length of stay, and increased cost. The methodology proposed to predict ICU readmission could improve the patients’ care. The objective of this work is to explore and evaluate the potential improvement of existing models for predicting early ICU patient readmission by using optimized artificial intelligence algorithms and explainability techniques. In this work, XGBoost is used as a predictor model, combined with Bayesian techniques to optimize it. The results obtained predicted early ICU readmission (AUROC of 0.92 ± 0.03) improves state-of-the-art consulted works (whose AUROC oscillate between 0.66 and 0.78). Moreover, we explain the internal functioning of the model by using Shapley Additive Explanation-based techniques, allowing us to understand the model internal performance and to obtain useful information, as patient-specific information, the thresholds from which a feature begins to be critical for a certain group of patients, and the feature importance ranking.

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Predicting Readmission to Intensive Care After Cardiac Surgery Within Index Hospitalization: A Systematic Review

Cited by 4 publications

References 46 publications

ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering

ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering

First initiation of mobilization out of bed after cardiac surgery – an observational cross-sectional study in Sweden

Improving Intensive Care Unit Early Readmission Prediction Using Optimized and Explainable Machine Learning

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