Characteristics of Survivors and Non-Survivors after Prolonged Intensive Care Unit Stay following Cardiac Surgery.
CCCF ePoster library. Lévesque E. Oct 26, 2015; 114778; P22
Dr. Emilie Lévesque
Dr. Emilie Lévesque
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Abstract
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P22


Topic: Retrospective or Prospective Cohort Study


Characteristics of Survivors and Non-Survivors after Prolonged Intensive Care Unit Stay following Cardiac Surgery.



Emilie Lévesque, C. Salois, Y. Lamarche, A. Denault

Intensive care, Université de Montréal, Montréal, Canada | Médecine, Université de Montréal, Montréal, Canada | cardiac surgery and intensive care, Institut de cardiologie de Montréal, Montréal, Canada | Anesthesiology, Institut de cardiologie de Montréal, Montréal, Canada

Introduction:

Prolonged Intensive Care Unit (ICU) stay has been associated with decline in long-term survival, costly hospitalization and need for community-based resources. Identifying characteristics associated with survival after prolonged ICU stay following cardiac surgery may assist teams in decision making.



Objectives:

The primary objective was to compare survivors and non survivors of a prolonged ICU stay following cardiac surgery.



Methods:

This retrospective observational cohort study was performed at the Institut de cardiologie de Montréal. All patients between January 2013 and December 2014 undergoing cardiac surgery and with an ICU length of stay of 10 days or more were included in the study. Demographics data, type of surgery and complications were collected.



Results:

Out of 3600 surgical cases, 151 patients met the inclusion criteria (4.2% of all surgical cases). Sixty-six percent were male. Female were overrepresented in the non-survivors (47.3%). Death in hospital occurred in 12.6%. Coronary artery bypass grafting was performed in 50.3% of the cohort (42.1% in non survivors and 51.5% in survivors). Aortic valve replacement accounted for 36.4% of the cohort but 47.4 % of the non survivors had this type of surgery. Mitral valve replacement was 10.6% but 15.8% in non survivors and 9.9% in survivors. Cardiac transplantation was 8.0% of the population.

The overall median ICU length of stay was 15 days (IQR 11-22) and median hospital length of stay was 28 days (IQR 21-40). In survivors, median ICU length of stay was 15 days (IQR 11-21) and median hospital length of stay was 28 days (IQR 21-39). In non survivors, median ICU length of stay was 19 days (IQR 12-33) and median hospital length of stay was 28 days (IQR 15-43).

Among medical complications, most common in non survivors were acute renal failure (94.7%), stroke (73.7%) and delirium (63.2%). However, acute renal failure (75.8%), stroke (7.6%) and delirium (56.8%) were less frequent in survivors.



Conclusion:

A small proportion of patients have a prolonged ICU stay following cardiac surgery. In this cohort, non survivors were mostly females and had an aortic valve replacement more frequently. Adverse events were more frequent among non survivors with elevated incidences of acute renal failure and stroke. Models predicting the occurrence of prolonged ICU stay and their outcome are needed in order to implement preventive strategies and to improve family counseling.



References:

1. Bapat V, Allen D, Young C, Roxburgh J, Ibrahim M, Survival and quality of life of cardiac surgery complicated by prolonged Intensive. Care. J Card Surg. 2005;20 :212-7

2. Gaudino M, Girola F, Piscitelli M, et al. Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay : unmasking an apparent success. J Thorac Cardiovasc Surg 2007;134 :465-9

3. Soppa G, Woodford C, Yates M, Shetty R, Moore M, Valencia O, et al. Functional status and survival after prolonged intensive care unit stay following cardiac surgery. Interact Cardiovasc Thorac Surg. 2013 Jun;16(6):750-4

4. Tu JV, Mazer CD: Can clinicians predict ICU length of stay following cardiac surgery? Can J Anaesth 1996;43:789-794.

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