Association between 24/7 intensivist-only management and post-operative adverse events, health resource utilization and outcomes among cardiac surgery patients: a propensity matched cohort study
CCCF ePoster library. Benoit M. Oct 26, 2015; 117312; P49
Dr. Marc Benoit
Dr. Marc Benoit
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Abstract
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P49


Topic: Retrospective or Prospective Cohort Study


Association between 24/7 intensivist-only management and post-operative adverse events, health resource utilization and outcomes among cardiac surgery patients: a propensity matched cohort study



Marc Benoit, S. Bagshaw, C. Norris, W. Chin, M. Zibdawi, D. Ross

Critical Care Cardiology, University of Alberta, Edmonton, Canada | Critical Care, University of Alberta, Edmonton, Canada | Medicine & Public Health, University of Alberta, Edmonton, Canada | Critical Care, University of Alberta, Edmonton, Canada | Critical Care, University of Alberta, Edmonton, Canada | Cardiac Surgery, University of Alberta, Edmonton, Canada

Introduction: Nighttime intensivist staffing does not improve patient outcomes in general medical or surgical intensive care units. To date, limited data has examined the impact of dedicated in-house 24/7 intensivist coverage on post-operative complications, resource utilization and outcomes for patients supported in specialized cardiovascular surgical intensive care units (CSICU).

Objectives:

To evaluate the impact of a change in nighttime CSICU coverage from resident in-house care model to a 24/7 in-house intensivist care model on post-operative clinical and resource utilization outcomes.



Methods:

A total of 1,484 patients ≥ 18 years in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry who underwent cardiac surgery at an academic center between January 1, 2004 to April 30, 2013 (nighttime resident/fellow in-house care model) were propensity matched (1:1) to patients undergoing surgery between August 1, 2013 to December 31, 2014 (24/7 in-house intensivist model). Regression modelling was used to control for monthly surgical volume and the number of CSICU beds. The primary outcome was a composite of post-operative major complications. Secondary outcomes were duration of mechanical ventilation, CSICU length of stay (LOS), all-cause CSICU readmission, and surgical cancellations attributed to lack CSICU bed availability.



Results:

Post-operative major complications, adjusted for volume of open heart surgeries and CSICU beds, were lower with the 24/7 intensivist model (46.7% vs 41.4%, p=0.03; Table). Mean mechanical ventilation time (36.1 hrs vs 31.8 hrs, p<0.001), all-cause CSICU readmissions (3.42% vs 1.63%, p= 0.003), and the number of surgeries cancelled due to lack of CSICU beds (2.54 vs 0.96 per month, p<0.001) were significantly lower with the 24/7 intensivist model. However, mean CSICU LOS was longer (3.11 days vs 3.44 days; p<0.001). No significant differences were observed in CSICU mortality (0.92% vs 1.27%, p=0.37) or 30-day mortality (1.71% vs 2.56%; p=0.14).



Conclusion:

A 24/7 in-house intensivist care model is associated with a reduced incidence of post-operative major complications, duration of mechanical ventilation, CSICU readmissions, and surgical cancellations due to CSICU bed availability. These findings suggest 24/7 intensivist physician care models improve patient outcomes and health resource utilization in dedicated CSICUs.



References:

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