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Mittelfristiges Outcome kardiochirurgischer Patienten mit einer verlängerten postoperativen Intensivtherapie

Mid-term outcome of cardiac surgery patients with prolonged postoperative intensive care treatment

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Intensivmedizin und Notfallmedizin

Zusammenfassung

Hintergrund

Herzchirurgische Patienten werden immer älter und kränker. Für den Erfolg einer Operation kommt daher, neben dem kardiochirurgischen Eingriff selbst, der postoperativen Intensivtherapie wachsende Bedeutung zu. Wir untersuchten das mittelfristige Outcome nach einem protrahierten postoperativen Intensivaufenthalt und welche perioperativen Faktoren mit einer ungünstigen Prognose assoziiert sind.

Material und Methoden

Alle Patienten, die von Anfang 2000 bis Ende 2004 in unserer Klinik am Herzen operiert wurden und postoperativ 1 Woche und länger auf der herzchirurgischen Intensivstation behandelt werden mussten, wurden untersucht. Patienten mit komplexen angeborenen Herzfehlern oder nach Herz- oder Lungentransplantation wurden ausgeschlossen. Von 230 Patienten wurden 31 perioperative Variablen erfasst; das Follow-up erfolgte 1 Jahr postoperativ.

Ergebnisse

Von den Patienten mit herzchirurgischem Eingriff benötigten 4,3% einen verlängerten Intensivaufenthalt. Die Einjahressterblichkeit der Langzeitlieger betrug 26,9%. Der stärkste Prädiktor für den Tod binnen des ersten postoperativen Jahres war das postoperative Nierenversagen mit der Notwendigkeit zur vorübergehenden Dialysebehandlung (Odds Ratio 4,98), gefolgt von der postoperativen Tracheotomie und präoperativ bekanntem Vorhofflimmern.

Schlussfolgerung

Das mittelfristige Überleben der untersuchten Patienten mit kompliziertem Verlauf nach einer Herzoperation ist erfreulich hoch. Die identifizierten Risikofaktoren für eine schlechte Prognose können Ansatzpunkte für weitere Therapieverbesserungen und generelle Therapieentscheidungen geben.

Abstract

Background

The number of patients of advanced age and with severe comorbidities undergoing cardiac surgery is rising. Therefore, in addition to the cardiac surgery procedure itself, postoperative intensive care treatment plays an increasingly important role. The mid-term outcome of patients with postoperative long-term stays in intensive care and perioperative risk factors for an adverse outcome have not been sufficiently evaluated.

Material and methods

All patients who underwent cardiac surgery in our institution between 2000 and 2004 and who required intensive care treatment on our cardiac surgery intensive care unit for at least 1 week were analyzed. Patients who received heart or lung transplantation or surgery for congenital heart failure were excluded. A total of 31 perioperative variables were evaluated for 230 patients. Follow-up was performed 1 year postoperatively.

Results

In all, 4.3% of our patients required a prolonged stay in intensive care following cardiac surgery. Overall 1-year mortality among patients with a long-term stay in intensive care was 26.9%. The logistic regression identified postoperative renal failure requiring dialysis (OR 4.98) as the strongest predictor for mortality within the first year after surgery, followed by postoperative tracheotomy and preoperatively known atrial fibrillation.

Conclusion

Mid-term survival among patients who underwent cardiac surgery followed by a complicated postoperative course is encouragingly high. The risk factors identified for an adverse prognosis may be helpful in improving therapy strategies and general therapy decision-making.

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Literatur

  1. Allender S, Peto V, Scarborough P et al (2008) Coronary heart disease statistics. British Heart Foundation, London

  2. Bashour CA, Yared JP, Ryan TA et al (2000) Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med 28:3847–3853

    Article  PubMed  CAS  Google Scholar 

  3. Benjamin EJ, Wolf PA, D’Agostino RB et al (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952

    PubMed  CAS  Google Scholar 

  4. Ferguson TB, Hammill BG, Peterson ED et al (2002) A decade of change – risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg 73:480–489

    Article  PubMed  Google Scholar 

  5. Gersbach P, Tevaearai H, Revelly JP et al (2006) Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care? Eur J Cardiothorac Surg 29:466–472

    Article  PubMed  Google Scholar 

  6. Guglin M, Khan H (2010) Pulmonary hypertension in heart failure. J Card Fail 16:461–474

    Article  PubMed  Google Scholar 

  7. Heimrath OP, Buth KJ, Légaré JF et al (2007) Long-term outcomes in patients requiring stay of more than 48 hours in the intensive care unit following coronary bypass surgery. J Crit Care 22:153–158

    Article  PubMed  Google Scholar 

  8. Hein OV, Birnbaum J, Wernecke K et al (2006) Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg 81:880–885

    Article  PubMed  Google Scholar 

  9. Herman C, Karolak W, Yip AM et al (2009) Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery – development of an entirely preoperative scorecard. Interact Cardiovasc Thorac Surg 9:654–658

    Article  PubMed  Google Scholar 

  10. Hirose H, Amano A, Takahashi A et al (2001) Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine ≥2.0 mg/dl). Eur J Cardiothorac Surg 20:565–572

    Article  PubMed  CAS  Google Scholar 

  11. Huybregts RAJM, Morariu AM, Rakhorst G et al (2007) Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system. Ann Thorac Surg 83:1760–1767

    Article  PubMed  Google Scholar 

  12. Macura M, Mac Donald AL, Werner Haug et al (2005) The new demographic regime: Population challenges and policy responses, United Nations, New York Geneva

  13. Nilsson J, Algotsson L, Höglund P et al (2004) EuroSCORE predicts intensive care unit stay and costs of open heart surgery. Ann Thorac Surg 78:1528–1534

    Article  PubMed  Google Scholar 

  14. Ohata T, Kaneko M, Kuratani T et al (2005) Using the EuroSCORE to assess changes in the risk profiles of the patients undergoing coronary artery bypass grafting before and after the introduction of less invasive coronary surgery. Ann Thorac Surg 80:131–135

    Article  PubMed  Google Scholar 

  15. Schöttler L, Lutter G, Böning A et al (2008) Is there really a clinical benefit of using minimized extracorporeal circulation for coronary artery bypass grafting? Semin Thorac Cardiovasc Surg 56:65–70

    Article  Google Scholar 

  16. Schöttler J, Petersen S, Böning A et al (2004) Predictors for a prolonged intensive care stay after heart surgery. Semin Thorac Cardiovasc Surg 52:91

    Article  Google Scholar 

  17. Tu JV, Jaglal SB, Naylor CD (1995) Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation 91:677–684

    PubMed  CAS  Google Scholar 

  18. Van Caenegem O, Jacquet LM, Goenen M (2002) Outcome of cardiac surgery patients with complicated intensive care unit stay. Curr Opin Crit Care 8:404–410

    Article  Google Scholar 

  19. Welsby IJ, Bennett-Guerrero E, Atwell D et al (2002) The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg 94:1072–1078

    Article  PubMed  Google Scholar 

  20. Williams MR, Wellner RB, Hartnett EA et al (2002) Long-term survival and quality of life in cardiac surgical patients with prolonged intensive care unit length of stay. Ann Thorac Surg 73:1472–1478

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, 24105, Kiel, Deutschland

    J. Schöttler, A. Hagemann, C. Grothusen, S. Stohn, D. Pleger, M. von der Brelie, J. Cremer & N. Haake

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  1. J. Schöttler
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  2. A. Hagemann
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  3. C. Grothusen
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  4. S. Stohn
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  5. D. Pleger
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  6. M. von der Brelie
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  7. J. Cremer
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  8. N. Haake
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Correspondence to J. Schöttler.

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Schöttler, J., Hagemann, A., Grothusen, C. et al. Mittelfristiges Outcome kardiochirurgischer Patienten mit einer verlängerten postoperativen Intensivtherapie. Intensivmed 48, 503–509 (2011). https://doi.org/10.1007/s00390-010-0245-7

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  • DOI: https://doi.org/10.1007/s00390-010-0245-7

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