Systematic review of factors influencing length of stay in ICU after adult cardiac surgery

Abstract

BackgroundIntensive care unit (ICU) care is associated with costly and often scarce resources. In many parts of the world, ICUs are being perceived as major bottlenecks limiting downstream services such as operating theatres. There are many clinical, surgical and contextual factors that influence length of stay. Knowing these factors can facilitate resource planning. However, the extent at which this knowledge is put into practice remains unclear. The aim of this systematic review was to identify factors that impact the duration of ICU stay after cardiac surgery and to explore evidence on the link between understanding these factors and patient and resource management.MethodsWe conducted electronic searches of Embase, PubMed, ISI Web of Knowledge, Medline and Google Scholar, and reference lists for eligible studies.ResultsTwenty-nine papers fulfilled inclusion criteria. We recognised two types of objectives for identifying influential factors of ICU length of stay (LOS) among the reviewed studies. These were general descriptions of predictors and prediction of prolonged ICU stay through statistical models. Among studies with prediction models, only two studies have reported their implementation. Factors most commonly associated with increased ICU LOS included increased age, atrial fibrillation/ arrhythmia, chronic obstructive pulmonary disease (COPD), low ejection fraction, renal failure/ dysfunction and non-elective surgery status.ConclusionCardiac ICUs are major bottlenecks in many hospitals around the world. Efforts to optimise resources should be linked to patient and surgical characteristics. More research is needed to integrate patient and surgical factors into ICU resource planning.

Gambaran Acute Physiologic and Chronic Health Evaluation (APACHE) II, Lama Perawatan, dan Luaran Pasien di Ruang Perawatan Intensif Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung pada Tahun 2017

“…Indikator lama perawatan pasien dapat memberikan gambaran performa ICU. 4,5 Skor APACHE II, luaran, dan lama perawatan adalah indikator yang penting pada pelayanan kesehatan di ICU. Skor APACHE II dapat menggambarkan keadaan pasien sebelum masuk ICU.…”

Establishing a new cardiac surgery service in an Australian university hospital: Pitfalls and lessons learned

“…Another way to decrease costs was to reduce the time patients spent in the ICU after surgery. It is acknowledged that a lengthy ICU admission increases the cost of the service 33 and can produce bed-block and have negative impacts on cardiac surgery activity 34 . As the cardiac surgery at GCUH had been allocated only two beds in the ICU, maintaining a continuous flow of the daily surgeries can be achieved by ensuring timely patient transfer to the step-down unit.…”

“…As the cardiac surgery at GCUH had been allocated only two beds in the ICU, maintaining a continuous flow of the daily surgeries can be achieved by ensuring timely patient transfer to the step-down unit. ICU stay is a significant part of the hospital journey for cardiac surgery patients and the length of ICU stay after cardiac surgery is subjected to different clinical and non-clinical factors and may vary between one and seven days 34 . The implementation process encountered various barriers because of the complexity of the specialty.…”

Evaluation of Long-term Intensive Care Patients in a Cardiac Surgery Center

“…Studies have stated that nearly 19-45% of cases have lengthened intensive care duration after open-heart surgery (1,2). For lengthened intensive care duration, a variety of risk factors may be listed such as advanced age, chronic obstructive pulmonary disease (COPD), renal failure or dysfunction, atrial fibrillation, low ejection fraction, emergency surgery, previous history of cardiac surgery and inotrope support (3).…”