Intensive Care Medicine

, Volume 30, Issue 1, pp 88–95

Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting

  • Jan Bucerius
  • Jan F. Gummert
  • Thomas Walther
  • Nicolas Doll
  • Volkmar Falk
  • Dierk V. Schmitt
  • Friedrich W. Mohr
Original
  • 214 Downloads

Abstract

Objective

To define predictors for prolonged ICU stay in order to improve patient outcome and reduce costs.

Patients and methods

Prospective data on 10,759 patients undergoing coronary artery bypass grafting with and without use of cardiopulmonary bypass (coronary artery bypass grafting, CABG; n =8,917; off-pump coronary artery bypass grafting, OPCAB; n =765; minimally invasive direct coronary artery bypass grafting, MIDCAB; n =1,077) between April 1996 and August 2001 were subjected to univariate and, consecutively, to multivariate logistic regression analysis. Prolonged ICU stay was defined as intensive care treatment for three postoperative days and longer.

Measurements and results

Mean duration of ICU stay was 3.8±6.9 days; overall prevalence of prolonged ICU stay was 37.1%. The hospital mortality was 3.5% (ICU ≥3 days: 5.9%; ICU <3 days: 2.0%). Out of 39 selected pre- and intraoperative patient- and treatment-related variables, by univariate analysis, 32 variables having a high association with prolonged ICU stay were identified. Using a stepwise logistic regression model, 20 variables were shown to be independent predictors for prolonged ICU stay. Both OPCAB and MIDCAB surgery were identified as having a significantly lower association with prolonged ICU stay.

Conclusion

As prolonged ICU stay is associated with poor patient outcome and increased costs it is of utmost importance to identify patients at a high risk for prolonged ICU stay. More frequent off-pump CABG may optimize patient outcome.

Keywords

Cardiac surgery CABG Beating heart surgery Intensive care unit 

References

  1. 1.
    Ryan TA, Rady MY, Bashour A, Leventhal M, Lytle B, Starr NJ (1997) Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest 112:1035–1042PubMedGoogle Scholar
  2. 2.
    Tuman KJ, McCarthy RJ, March RJ, Najafi H, Ivankovich AD (1992) Morbidity and duration of ICU stay after cardiac surgery. A model for preoperative risk assessment. Chest 102:36–44PubMedGoogle Scholar
  3. 3.
    Rosenberg AL, Watts C (2000) Patients readmitted to ICUs. A systemic review of risk factors and outcomes. Chest 118:492–502PubMedGoogle Scholar
  4. 4.
    Warner CD, Weintraub WS, Craver JM, Jones EL, Gott JP, Guyton RA (1997) Effect of cardiac surgery patient characteristics on patient outcomes from 1981 through 1995. Circulation 96:1575–1579PubMedGoogle Scholar
  5. 5.
    Kalmár P, Irrgang E (2000) Cardiac surgery in Germany during 2000. A report by the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 48:33–38Google Scholar
  6. 6.
    Petros AJ, Marshall JC, van Saene HKF (1995) Should morbidity replace mortality as an end-point for clinical trials in intensive care? Lancet 345:369–371PubMedGoogle Scholar
  7. 7.
    Hammermeister M, Burchfield C, Johnson R, Grover FL (1990) Identification of patients at greatest risk for developing major complications after cardiac surgery. Circulation 82[Suppl]):380–389Google Scholar
  8. 8.
    Gummert JF, Kluge M, Reissmann EM, Bung J, Mohr FW (1998) Einführung eines komplexen medizinischen Dokumentationssystems am Herzzentrum Leipzig. In: Krian A, Scheld HH (ed) Dokumentationsverfahren in der Herzchirurgie III. Steinkopff, Darmstadt, pp 99–103Google Scholar
  9. 9.
    Rosner BA (1995) Fundamentals of biostatistics, 4th edn. Duxbury-Press, Belmont, Calif., USAGoogle Scholar
  10. 10.
    Tu JV, Jaglal SB, Naylor CD, and the Steering Committee of the Provincial Adult Cardiac Care Network of Ontario (1995) Multicenter validation of a risk index for mortality, intensive care unit stay and overall hospital length of stay after cardiac surgery. Circulation 91:677–684PubMedGoogle Scholar
  11. 11.
    Lynn GM, Stefanko K, Reed JF III, Gee W, Nicholas G (1992) Risk factors for stroke after coronary artery bypass. J Thorac Cardiovasc Surg 104:1518–1523PubMedGoogle Scholar
  12. 12.
    Newman MF, Wolman R, Kanchuger M, Marschall K, Mora-Mangano C, Roach G, Smith LR, Aggarwal A, Nussmeier N, Herskowitz A, Mangano DT (1996) Multicenter preoperativestroke risk index for patients undergoing coronary artery bypass graft surgery. Circulation 94[Suppl 2]:74–80Google Scholar
  13. 13.
    Horneffer PJ, Gardner TJ, Manolio TA, Hoff SJ, Rykiel MF, Pearson PA, Gott VL, Baumgartner WA, Borkon AM, Watkins L (1987) The effects of age on outcome after coronary bypass surgery. Circulation 76:6–12PubMedGoogle Scholar
  14. 14.
    Avery II GJ, Ley SJ, Hill D, Hershon JJ, Dick SE (2001) Cardiac surgery in the octogenerian: evaluation of risk, cost, and outcome. Ann Thorac Surg 71:591–596CrossRefPubMedGoogle Scholar
  15. 15.
    Roach GW, Kanchuger M, Mora Mangano C, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C (1996) Adverse cerebral outcomes after coronary bypass surgery. Multicenter study of perioperative ischemia research group and the ischemia research and education foundation investigators. N Engl J Med 335:1857–1863CrossRefPubMedGoogle Scholar
  16. 16.
    Stamou SC, Hill PC, Dangas G, Pfister AJ, Boyce SW, Dullum MK, Bafi AS, Corso PJ (2001) Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke 32:1508–1513PubMedGoogle Scholar
  17. 17.
    Morricone L, Ranucci M, Denti S, Cazzaniga A, Isgro G, Enrini R, Caviezel F (1999) Diabetes and complications after cardiac surgery: comparison with a non-diabetic population. Acta Diabetol 36:77–84CrossRefPubMedGoogle Scholar
  18. 18.
    Rorich MB, Furlan AJ (1990) Risk at cardiac surgery in patients with prior stroke. Neurology 40:835–837PubMedGoogle Scholar
  19. 19.
    Shaw PJ, Bates D, Cartlidge NEF, French JM, Heaviside D, Julian DG, Shaw DA (1989) An analysis of factors predisposing to neurological injury in patients undergoing coronary bypass operations. Q J Med 72:633–646PubMedGoogle Scholar
  20. 20.
    Hammon JW Jr, Stump DA, Kon ND, Cordell AR, Hudspeth AS, Oaks TE, Brooker RF, Rogers AT, Hilbawi R, Coker LH, Troost BT (1997) Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg 63:1613–1618CrossRefPubMedGoogle Scholar
  21. 21.
    Clark RE, Brillman J, Davis DA, Lovell MR, Price TR, Magovern GJ (1995) Microemboli during coronary artery bypass grafting. Genesis and effect on outcome. J Thorac CardiovascSurg 109:249–257Google Scholar
  22. 22.
    Kurki TSO, Kataja M (1996) Preoperative prediction of postoperative morbidity in coronary artery bypass grafting. Ann Thorac Surg 61:1740–1745CrossRefPubMedGoogle Scholar
  23. 23.
    Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranadi L (1992) Stratification of morbidity and mortality outcome by preoperative risk factors in coroanry artery bypass patients. JAMA 267:2344–2348PubMedGoogle Scholar
  24. 24.
    Anderson RJ, O' Brian M, MaWhinney S, Villa Nueva CB, Moritz TE, Sethi GK, Henderson WG, Hammermeister KE, Grover FL, Shroyer AL (1999) Renal failure predisposes patients to adverse outcome after coronary bypass surgery. Kidney Int 55:1057–1062CrossRefPubMedGoogle Scholar
  25. 25.
    Hannan EL, Kilburn H, O'Donnell J, Lukacik G, Shields EP (1990) Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates. JAMA 264:2768–2774CrossRefPubMedGoogle Scholar
  26. 26.
    Murkin JM, Boyd WD, Ganapathy S, Adams SJ, Peterson RC (1999) Beating heart surgery: why expect less central nervous system morbidity? Ann Thorac Surg 68:1498–1501CrossRefPubMedGoogle Scholar
  27. 27.
    Kshettry VE, Flavin TF, Emery RW, Nicoloff DM (2000) Does multi-vessel off-pump coronary artery bypass (OPCABG) reduce postoperative morbidity? Ann Thorac Surg 69:1725–1730PubMedGoogle Scholar
  28. 28.
    Mack MJ, Osborne JA, Shennib H (1998) Arterial graft patency in coronary artery bypass grafting: what do we really know? Ann Thorac Surg 66:1055–1059CrossRefPubMedGoogle Scholar
  29. 29.
    Bull DA, Neumayer LA, Stringham JC, Meldrum P, Affleck DG, Karwande SV (2001) Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost? Ann Thorac Surg 71:170–175CrossRefPubMedGoogle Scholar
  30. 30.
    Plomondon ME, Cleveland JC, Ludwig ST, Grunwald GK, Kiefe CI, Grover FL, Shroyer AL (2001) Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 72:114–119CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Jan Bucerius
    • 1
  • Jan F. Gummert
    • 1
  • Thomas Walther
    • 1
  • Nicolas Doll
    • 1
  • Volkmar Falk
    • 1
  • Dierk V. Schmitt
    • 1
  • Friedrich W. Mohr
    • 1
  1. 1.Department of Cardiac SurgeryHeart Center, University of LeipzigLeipzigGermany

Personalised recommendations