Very Prolonged Stay in the Intensive Care Unit After Cardiac Operations: Early Results and Late Survival

Silberman, Shuli; Bitran, Daniel; Fink, Daniel; Tauber, Rachel; Merin, Ofer

doi:10.1016/j.athoracsur.2013.01.103

Cited by 28 publications

(59 citation statements)

References 22 publications

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“…As for ICU, several studies reported a high incidence of AEs ranging from 6.9 to 39.2% [36–44]. Moreover, the incidence of adverse events, according to Silberman et al, is proportional to the duration of ICU stay [45]. …”

Section: Discussionmentioning

confidence: 99%

The incidence of adverse events in an Italian acute care hospital: findings of a two-stage method in a retrospective cohort study

Sommella

Waure

Ferriero

et al. 2014

BMC Health Serv Res

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BackgroundThe promotion of safer healthcare interventions in hospitals is a relevant public health topic. This study is aimed to investigate predictors of Adverse Events (AEs) taking into consideration the Charlson Index in order to control for confounding biases related to comorbidity.MethodsThe study was a retrospective cohort study based on a two-stage assessment tool which was used to identify AEs. In stage 1, two physicians reviewed a random sample of patient records from 2008 discharges. In stage 2, reviewers independently assessed each screened record to confirm the presence of AEs. A univariable and multivariable analysis was conducted to identify prognostic factors of AEs; socio-demographic and some main organizational variables were taken into consideration. Charlson comorbidity Index was calculated using the algorithm developed by Quan et al.ResultsA total of 1501 records were reviewed; mean patients age was 60 (SD: 19) and 1415 (94.3%) patients were Italian. Forty-six (3.3%) AEs were registered; they most took place in medical wards (33, 71.7%), followed by surgical ones (9, 19.6%) and intensive care unit (ICU) (4, 8.7%). According to the logistic regression model and controlling for Charlson Index, the following variables were associated to AEs: type of admission (emergency vs elective: OR 3.47, 95% CI: 1.60-7.53), discharge ward (surgical and ICU vs medical wards: OR 2.29, 95% CI: 1.00-5.21 and OR 4.80, 95% CI: 1.47-15.66 respectively) and length of stay (OR 1.03, 95% CI 1.01-1.04). Among patients experiencing AEs a higher frequency of elderly (≥65 years) was shown (58.7% vs 49.3% among patients without AEs) but this difference was not statistically significant. Interestingly, a higher percentage of patients admitted through emergency department was found among patients experiencing AEs (69.7% vs 55.1% among patients without AEs).ConclusionsThe incidence of AEs was associated with length of stay, type of admission and unit of discharge, independently by comorbidity. On the basis of our results, it appears that organizational characteristics, taking into account the adjustment for comorbidity, are the main factors responsible for AEs while patient vulnerability played a minor role.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-358) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The incidence of adverse events in an Italian acute care hospital: findings of a two-stage method in a retrospective cohort study

Sommella

Waure

Ferriero

et al. 2014

BMC Health Serv Res

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“…In addition, the results of our collaborators and those from a recently published study revealed that the preoperatively assessed EuroSCORE I inversely correlated to the postoperatively measured selenium levels (r = -0.312, P <0.01), indicating that this group would be most likely to benefit from perioperative selenium supplementation [ 9 ]. These same criteria enabled the identification of patients who were likely to experience a prolonged ICU course [ 13 ], which will offer some statistical efficiencies given the higher rate of organ dysfunction and need for prolonged administration of life-sustaining therapies.…”

Section: Methodsmentioning

confidence: 99%

SodiUm SeleniTe Adminstration IN Cardiac Surgery (SUSTAIN CSX-trial): study design of an international multicenter randomized double-blinded controlled trial of high dose sodium-selenite administration in high-risk cardiac surgical patients

Stoppe

McDonald

Rex

et al. 2014

Trials

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BackgroundCardiac surgery has been shown to result in a significant decrease of the antioxidant selenium, which is associated with the development of multiorgan dysfunction and increased mortality. Thus, a large-scale study is needed to investigate the effect of perioperative selenium supplementation on the occurrence of postoperative organ dysfunction.Methods/DesignWe plan a prospective, randomized double-blind, multicenter controlled trial, which will be conducted in North and South America and in Europe. In this trial we will include 1,400 high-risk patients, who are most likely to benefit from selenium supplementation. This includes patients scheduled for non-emergent combined and/or complex procedures, or with a predicted operative mortality of ≥5% according to the EuroSCORE II. Eligible patients will be randomly assigned to either the treatment group (bolus infusion of 2,000 μg sodium selenite immediately prior to surgery, followed by an additional dosage of 2,000 μg at ICU admission, and a further daily supplementation of 1,000 μg up to 10 days or ICU discharge) or to the control group (placebo administration at the same time points).The primary endpoint of this study is a composite of 'persistent organ dysfunction’ (POD) and/or death within 30 days from surgery (POD + death). POD is defined as any need for life-sustaining therapies (mechanical ventilation, vasopressor therapy, mechanical circulatory support, continuous renal replacement therapy, or new intermittent hemodialysis) at any time within 30 days from surgery.DiscussionThe SUSTAIN-CSX™ study is a multicenter trial to investigate the effect of a perioperative high dosage sodium selenite supplementation in high-risk cardiac surgical patients.Trial registrationThis trial was registered at Clinicaltrials.gov (identifier: NCT02002247) on 28 November 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-339) contains supplementary material, which is available to authorized users.

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“…5,9,10,[18][19][20]22 Notably, mortality is highest in the first 6 months to 1 year postdischarge, indicating that more comprehensive follow-up and surveillance is required in this time. 5,10,15,19 Follow-up of cardiac surgery patients typically occurs 6 to 12 weeks postoperatively 29 ;…”

Section: Conclusion and Implications For Clinical Practicementioning

confidence: 99%

“…The most common method of comparison was using a 'normal' LOS group versus a 'prolonged' LOS group; however a lack of standardized definition of 'prolonged' means that, although similar methodology was used, results may differ widely. Silberman et al15 considered normal LOS to be <2 days, therefore used ITU LOS of <2 days as the control vs the comparison groups of 2 to 14 days and >14 days, whereas Hein et al5 classified It would seem that they are to be classified as having had a prolonged LOS, as only 4.7% of the 2250 cohort were categorized into Group A or B, indicating that the remaining 95.3% either had an uneventful postoperative course and subsequent discharge from ITU or died postoperatively, although why comparison was not made with those of "normal" ITU LOS instead is not addressed by the authors. Second, there was wide disparity in sample sizes between studies.…”

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confidence: 99%

The long‐term effects of prolonged intensive care stay postcardiac surgery

Mackie-Savage

Lathlean

2020

Journal of Cardiac Surgery

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Objectives: Short-term outcomes for those with a prolonged length of stay (LOS) in intensive care (ITU) following cardiac surgery are poor, with higher rates of inhospital mortality and morbidity. Consequently, discharge from hospital has been considered the key measure of success. However, there has been a shift towards long-term outcomes, functional recovery and quality of life (QoL) as measures of surgical quality. The aim of this review is to compare and critique the findings of multiple studies to determine the long-term effects of prolonged ITU stay postcardiac surgery. Methods: A computerized literature search of CINAHL, EMBASE and Google Scholar databases, based on keywords "long-term effects," "prolonged ITU stay," "cardiac surgery," with rigorous CASP critique was undertaken. Results: The search yielded 12 papers meeting the inclusion criteria, with eight retrospective and four prospective studies. Eight of these 12 papers identified inferior long-term survival or higher mortality rates for those who had prolonged LOS in ITU in comparison to "normal" LOS or a control. The greatest burden of mortality was 6 months to 1 year postdischarge. Three papers found that quality of life was adversely affected or worse for those who had experienced prolonged LOS in ITU. Conclusions: Further research is required to provide better quality evidence into QoL, following prolonged stay in ICU postcardiac surgery. The evidence reviewed suggests that the risk of mortality in this demographic of patients is higher, especially within the first year and, therefore, more frequent medical surveillance of these patients is recommended.

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Very Prolonged Stay in the Intensive Care Unit After Cardiac Operations: Early Results and Late Survival

Cited by 28 publications

References 22 publications

The incidence of adverse events in an Italian acute care hospital: findings of a two-stage method in a retrospective cohort study

The incidence of adverse events in an Italian acute care hospital: findings of a two-stage method in a retrospective cohort study

SodiUm SeleniTe Adminstration IN Cardiac Surgery (SUSTAIN CSX-trial): study design of an international multicenter randomized double-blinded controlled trial of high dose sodium-selenite administration in high-risk cardiac surgical patients

The long‐term effects of prolonged intensive care stay postcardiac surgery

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