Predictors of Operative Mortality in Cardiac Surgical Patients with Prolonged Intensive Care Unit Duration

Abstract

Background Several systems have been developed to predict mortality following intensive care unit (ICU) admission in medical and surgical patients. However, a similar tool specific to cardiac surgical patients with prolonged intensive care unit duration does not exist. The purpose of the present study was to identify independent perioperative predictors of operative mortality among cardiac surgical patients with prolonged ICU duration. Study Design From 2003-2008, 13,105 cardiac surgical patients with ICU durations greater than 48 hours were identified within a statewide database. Perioperative factors, including Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM), were evaluated. Univariate and multivariate analyses identified significant correlates of operative mortality and their relative strength of association as determined by the Wald χ2 statistic. Results Mean patient age was 66.8±11.2 years, median ICU duration was 76.5 [56.0-124.0] hours, and mean STS PROM was 4.4%±6.2%. Among preoperative and operative factors, intra-aortic balloon pump use, patient age, immunosuppressive therapy, hemodialysis requirement, cardiopulmonary bypass time, and heart failure proved to be the strongest correlates of mortality (all p<0.05) on risk-adjusted multivariate analysis. Interestingly, type of cardiac procedure had no significant association with mortality after risk adjustment. Among postoperative complications, cardiac arrest, prolonged mechanical ventilation (>24 hours) and stroke were the strongest predictors of risk-adjusted mortality (all p<0.001). Conclusions Operative mortality may be predicted by select risk factors for cardiac surgical patients with prolonged intensive care unit duration. Patient age, preoperative intra-aortic balloon pump, and postoperative cardiac arrest, prolonged ventilation and stroke have the strongest association with mortality. Identification of these factors in the perioperative setting may enhance resource utilization and improve mortality following cardiac surgery.

Factors associated with intubation extended in patients who undewent a heart surgery

“…Similar results were found in other studies (FINZI, 2010;WIDYASTUTI et al, 2012;LAPAR et al, 2013.). While the benefits of this procedure are patent, such as the increase in the patient survival, it is not risk-free, being of extremely importance the pre and post-operative evaluation of these patients in order to identify risk factors and to plan an individualized and preventive care.…”

Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery

“…[5][6][7][8][9] The Society of Thoracic Surgeons describes an ICU stay Ͼ 48 h as long and related to prolonged mechanical ventilation (Ͼ24 h) and an increase in mortality. 10 An inverse relationship was observed between prolonged mechanical ventilation and short-term survival in critical surgery patients, 11 and the main predictor of mortality in patients under prolonged mechanical ventilation was found to be multiple organ failure. 12 Despite the very high mortality among the relatively small percentage of patients who require prolonged mechanical ventilation after cardiac surgery, 10,[12][13][14] they have not been identified as a group with special care needs.…”

“…10 An inverse relationship was observed between prolonged mechanical ventilation and short-term survival in critical surgery patients, 11 and the main predictor of mortality in patients under prolonged mechanical ventilation was found to be multiple organ failure. 12 Despite the very high mortality among the relatively small percentage of patients who require prolonged mechanical ventilation after cardiac surgery, 10,[12][13][14] they have not been identified as a group with special care needs. There appears to have been insufficient research on the situation of these patients, as reflected in the minimal space allocated to their treatment in clinical practice guidelines.…”

Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD: a randomised clinical trial

“…[1][2][3][4][5] The aetiology is multifactorial and can be separated into poor postoperative lung mechanics and abnormal gas exchange. However, CPB is considered to be the main contributor to postoperative KEY MESSAGES ▸ Although the technical refinement of cardiopulmonary bypass (CPB) has progressively improved the surgical outcomes of heart diseases, postoperative CPB-induced lung dysfunction still remains an important contributing factor to increased morbidity and mortality, especially for patients with chronic obstructive pulmonary disease (COPD).…”

“…pulmonary dysfunction due to (1) contact of blood with the heart-lung machine's artificial surfaces, (2) perfusion of only the systemic circulation and not the pulmonary circuit with non-physiological laminar flow, resulting in (3) release of endotoxins from the splanchnic area, and after weaning from CPB (4) warm ischaemic reperfusion injury of especially the lungs, all leading to activation of the inflammatory response and consequently interstitial pulmonary oedema. [6][7][8] The lungs have a dual blood supply from the pulmonary and bronchial arteries with extensive collateral connections.…”