Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting
- 260 Downloads
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.
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.
KeywordsCardiac surgery CABG Beating heart surgery Intensive care unit
- 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
- 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.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.Rosner BA (1995) Fundamentals of biostatistics, 4th edn. Duxbury-Press, Belmont, Calif., USAGoogle Scholar
- 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
- 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
- 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