Mortality and Functional Outcomes after Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review
CCCF ePoster library. Trivedi V. Oct 2, 2017; 198198
Dr. Vatsal Trivedi
Dr. Vatsal Trivedi
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Abstract
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Mortality and Functional Outcomes after Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review

 

Authors and Affiliations:

Dr. Vatsal Trivedi, MD, Department of Anesthesiology and Pain Medicine, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, University of Ottawa, Canada, vtriv086@uottawa.ca

 

Ms. Helena Bleeker, BSc, Faculty of Medicine, 451 Smyth Road, Room 2046, Ottawa, ON, K1H 8M5, University of Ottawa, Canada, hblee035@uottawa.ca

 

Mr. Navot Kantor, BSc, Faculty of Medicine, 451 Smyth Road, Room 2046, Ottawa, ON, K1H 8M5, University of Ottawa, Canada, nkant083@uottawa.ca

 

Ms. Sarah Visintini, BA, MLIS, Berkman Library, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, University of Ottawa Heart Institute, Canada, svisinti@uottawa.ca

 

Dr. Daniel McIsaac, MD, MPH, FRCPC, Department of Anesthesiology and Pain Medicine, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, University of Ottawa, Canada, dmcisaac@toh.ca

 

Dr. Bernard McDonald, MD, PhD, FRCPC, Division of Cardiac Anesthesiology, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, University of Ottawa Heart Institute, Canada, bmcdonald@ottawaheart.ca

 

 


Introduction
While the majority of patients undergoing cardiac surgical procedures recover without significant morbidity in the post-operative phase, up to one third of patients have their postoperative care complicated by major morbidity requiring prolonged intensive care. There is a knowledge gap with respect to how these prolonged stay patients recover, and whether they enjoy adequate functional outcomes and quality of life in both short and long term follow up. 
 
Objectives
To determine both in-hospital and long term mortality and functional outcomes in patients with prolonged stays in the intensive care unit following cardiac surgery.
 
Methods
This systematic review was designed following PRISMA reporting guidelines, and the protocol was registered with PROSPERO (CRD42017046535).  Searches were conducted in MEDLINE, Embase, CINAHL, Web of Science databases, and Dissertations & Theses Global in September 2016. Studies were included if they assessed either in-hospital or long term mortality and/or functional outcomes in adult patients with prolonged intensive care stays following major cardiac surgery. Studies were excluded if they included pediatric, pregnant, or trauma patients. Two authors independently reviewed all references for eligibility, data extraction, and appraised study quality.
 
Results
After screening 7838 citations and 110 full text articles, 33 studies were included. The definition of prolonged stay in the ICU was variable, ranging from greater than 2 days to greater than 14 days. These patients made up a range of 1.8% to 28.8% of ICU patients post cardiac surgery.
 
27 studies evaluated in-hospital mortality in prolonged ICU stay, with a range of 10% to 45%, compared to a range of 0.8% to 13% in patients with a normal ICU stay. The studies with longer definition of prolonged stay demonstrated higher in-hospital mortality compared to those with shorter definitions of prolonged stay.
 
Long term mortality was assessed in 23 studies. Survival at 1 year was assessed in 12 studies with a range from 51.9% to 91.2% in prolonged stay, which was decreased compared to normal stay (range 81.2%-97%, 7 studies). Survival at 5 years was evaluated in 10 studies with lower survival in prolonged stay (range 30%-68%, 10 studies), compared to normal stay (range 76%-88%, 8 studies). Studies with longer definition of prolonged stay demonstrated lower long term survival compared to those with shorter definitions.
 
Long term functional outcomes and quality of life were assessed in 13 studies. Of 6 studies at 1 year follow up, 5 demonstrated minimal functional impairment, with the majority of patients with prolonged stay being independent with activities of daily living, and good mobility and mental summary scores. At 5 year follow up, 3 studies demonstrated independence with activities of daily living in the majority of patients, with good mobility scores and self-reported health as “good” or “excellent”.
 
The most common risk factors for prolonged ICU stay included age > 70, renal failure, respiratory failure, diabetes, and urgent/emergent surgery. Due to heterogenous definitions of prolonged length of stay, meta-analysis was deferred.
 
Conclusion
Patients with prolonged ICU stay following cardiac surgery appear to be at higher risk of in-hospital and long term mortality. However, survivors appear to enjoy good long term functional status and quality of life, possibly justifying the significant resource demand during their ICU stay. 
 

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