Readmission To Intensive Care Unit After Coronary Bypass Operations in the Short Term

Abstract

Objective: Intensive care unit (ICU) readmissions after coronary bypass (CABG) operations occur in a significant number of patients, and the prognosis is poor. We analyzed the risk factors for ICU readmissions after CABG operations. Methods:We retrospectively analyzed the prospectively collected data of 679 coronary bypass patients operated in a single institution in order to evaluate the risk factors for readmittance to the ICU with logistic regression analysis. The outcome results of patients readmitted to the ICU (Group R) and others (Group N) were compared.Results: Thirty-six (5.3%) patients were readmitted to the ICU. Postoperative in-hospital mortality and pulmonary and neurologic morbidity occurred in 43 (6.3%), 135 (19.9%), and 46 (6.8%) patients, respectively. The comparison of groups showed that mortality and morbidity were significantly higher in Group R compared to Group N (mortality 16.7% vs. 5.9, p=0.029; pulmonary morbidity 66.7% vs. 17.3%, p=0.0001; neurologic morbidity 38.9% vs. 5.0%, p=0.0001). Features associated with readmission included presence of left ventricular dysfunction preoperatively[odds ratio (OR)=4.1; 95% confidence interval (CI)=1.4-12.5; p=0.013], advanced NYHA Class (OR=5.3; 95% CI=1.3-21.7; p=0.022), pulmonary complications (OR=7.3; 95% CI=2.1-25.5; p=0.002), and neurologic complications (OR=4.6; 95% CI=1.3-16.7; p=0.021). Conclusion:Patients readmitted to the ICU postoperatively have higher rates of mortality and pulmonary and neurologic morbidity after coronary bypass operations. Left ventricular dysfunction, advanced NYHA class, and postoperative pulmonary and neurologic complications are significant risk factors for readmission to the ICU.Key Words: Coronary artery bypass, readmission, intensive care, risk factors Abstract Introduction I n the postoperative recovery period, intensive care unit (ICU) stay is necessary after coronary bypass (CABG) operations in the majority of centers. Particularly, the first few hours are critical for the risk of myocardial ischemia (1). Numerous postoperative problems have to be addressed correctly in this early postoperative period, such as hypertension, arrhythmias, bleeding, and so forth. Patients are transferred to the ICU on mechanical ventilation, and the sedated and intubated patient requires extreme caution during ICU care and extubation.During the recovery period, however, some problems may be encountered, so that patients may have to be readmitted to the ICU. Readmission to the ICU is associated with worse outcome (2). There are studies analyzing ICU readmissions in cardiac surgery patients (1-3); however, they are mostly focused on the fast track protocols. In our clinic, fast track protocols are not employed. Again, ICU readmissions occur in a significant number of patients, and the prognosis is also poor. We analyzed the risk factors for ICU readmissions after a heterogeneous group of CABG operations in a single institution. MethodsAfter approval by the institutional ethics board (Bağcılar Training and Research Hospital, Nonin...

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

“…32 In this review we identified three studies that demonstrated prolonged initial CICU stay was an independent risk factor for readmission to CICU. 24,37,38 Risk factors for readmission are related to but different from causes for readmission and we have assessed both in this review. The most common causes for readmission were respiratory or cardiac complications.…”

Analysis of Readmissions to The Intensive Care Unit After Coronary Artery Bypass Surgery: Ten Years’ Experience

“…This rate varies according to the patient’s profile, type of operation, and center characteristics. The ICU readmission rate after coronary artery bypass surgery was reported to be between 3.1 and 5.3% [ 15 , 16 ] . In our study, the ICU readmission rate was 3.5%, which was consistent with the literature.…”

“…Respiratory causes have been emphasized in many studies as the most common cause of ICU readmission [ 16 - 20 ] . In some series, cardiac causes were more pronounced [ 13 , 21 ] .…”

Evaluation of Readmitted Patients After Intensive Care Unit Discharge (Retrospective Study)

“…Choosing the right time to discharge a patient from ICU still remains a challenge (28). Discharging from ICU is protective against iatrogenic and nasocomial complications during ICU stay and it makes ICU available for efficient use and decreases costs (29).…”