Readmission to the intensive care unit after “fast-track” cardiac surgery: risk factors and outcomes

Kogan, Alexander; Cohen, Jonathan; Raanani, Ehud; Sahar, Gideon; Orlov, Boris; Singer, Pierre; Vidne, Bernardo A.

doi:10.1016/s0003-4975(03)00510-1

Cited by 80 publications

(73 citation statements)

References 16 publications

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“…These patients often have unresolved pain issues, fluid management challenges, diminished respiratory reserve, and other complications that can affect the continued recovery process outside the ICU. 13 Close attention to the respiratory-related needs of this population can reduce readmissions to the ICU. 14 To this end, respiratory therapists have been identified as important to improving patient outcomes outside the ICU.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions

et al. 2017

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BACKGROUND: The purpose of this retrospective medical record review was to report on recidivism to the ICU among adult postoperative cardiac and thoracic patients managed with a respiratory therapy assess-and-treat (RTAT) protocol. Our primary null hypothesis was that there would be no difference in all-cause unexpected readmissions and escalations between the RTAT group and the physician-ordered respiratory care group. Our secondary null hypothesis was that there would be no difference in primary respiratory-related readmissions, ICU length of stay, or hospital length of stay. METHODS: We reviewed 1,400 medical records of cardiac and thoracic postoperative subjects between January 2015 and October 2016. The RTAT is driven by a standardized patient assessment tool, which is completed by a registered respiratory therapist. The tool develops a respiratory severity score for each patient and directs interventions for bronchial hygiene, aerosol therapy, and lung inflation therapy based on an algorithm. The protocol period commenced on December 1, 2015, and continued through October 2016. Data relative to unplanned admissions to the ICU for all causes as well as respiratory-related causes were evaluated. RESULTS: There was a statistically significant difference in the all-cause unplanned ICU admission rate between the RTAT (5.8% [95% CI 4.3-7.9]) and the physician-ordered respiratory care (8.8% [95% CI 6.9 -11.1]) groups (P ‫؍‬ .034). There was no statistically significant difference in respiratory-related unplanned ICU admissions with RTAT (36% [95% CI 22.7-51.6]) compared with the physician-ordered respiratory care (53% [95% CI 41.1-64.8]) group (P ‫؍‬ .09). The RTAT protocol group spent 1 d less in the ICU (P < .001) and in the hospital (P < .001). CONCLUSIONS: RTAT protocol implementation demonstrated a statistically significant reduction in all-cause ICU readmissions. The reduction in respiratory-related ICU readmissions did not reach statistical significance.

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Section: Discussionmentioning

confidence: 99%

Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions

et al. 2017

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“…Several factors have been reported to be significantly associated with ICU readmissions by various authors (3,(10)(11)(12). Some of these are age, female sex, operations other than first time isolated CABG, high Bernstein-Parsonnet score, long cross-clamp times, high EuroSCORE, sternal dehiscence, ventricular arrhythmias, postoperative renal failure, and prolonged ventilation.…”

Section: Discussionmentioning

confidence: 99%

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

Gümüş¹,

Polat²,

Yektaş³

et al. 2014

Turk J Anesth Reanim

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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...

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“…27,28 Fentanyl at a dose of 10 to15 μg/kg at induction is commonly used in many centers. 2,16,17,28,24,26,30 Remifentanil was equally safe and effective as fentanyl with no difference in time to extubation. 21 We have maintained anaesthesia with propofol, isoflurane combination in the pre by-pass period.…”

Section: Methods Of Ftcamentioning

confidence: 99%

“…He also showed a significantly decreased time to extubation with no increase in the incidence of ischaemia or postoperative myocardial infarction. Since then propofol has been used commonly in cardiac anaesthesia, either as part of a total intravenous anaesthetic technique 5,23,28 or as sedation on CPB and continuing into the ICU. 2,5,17,22,24,25,26 The most common agent used for sedation of these patients post bypass and into the ICU is propofol.…”

Section: Methods Of Ftcamentioning

confidence: 99%

Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

et al. 2014

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Readmission to the intensive care unit after “fast-track” cardiac surgery: risk factors and outcomes

Cited by 80 publications

References 16 publications

Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions

Impact of a Respiratory Therapy Assess-and-Treat Protocol on Adult Cardiothoracic ICU Readmissions

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

Fast-Track Cardiac Anaesthesia at a Tertiary Care Cardiac Centre in Nepal

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