A case-control study of readmission to the intensive care unit after cardiac surgery.
A case-control study of readmission to the intensive care unit after cardiac surgery.
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DOI：
10.12659/msm.883814
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发表时间：
2013-02-28
期刊：
影响因子：
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通讯作者：
Kinduris S
中科院分区：
文献类型：
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作者：
Benetis R;Sirvinskas E;Kumpaitiene B;Kinduris S
本研究的目的是确定接受心脏手术的患者反复入住重症监护室（ICU）的预测因素。这项回顾性研究分析了2009年1月至2010年12月期间接受隔离冠状动脉旁路移植术（CABG）的169例患者。病例组包括54名在同一住院期间再次入住ICU的患者，对照组包括115名随机选择的患者。Logistic回归分析显示，CABG术后再入院ICU的独立预测因素为：（比值比[OR] 1.04; CI 1.004-1.08）;体重指数（BMI）>30 kg/m2（OR 2.55; CI 1.31-4.97）; EuroSCORE II >3.9%（OR 3.56; CI 1.59-7.98）;非择期手术（OR 2.85; CI 1.37-5.95）;手术时间>4 h（OR 3.44; CI 1.54-7.69）;转流时间>103 min（OR 2.5; CI 1.37-4.57）;机械通气>530 min（OR 3.98; CI 1.82-8.7）;和术后中枢神经系统（CNS）疾病（OR 3.95; CI 1.44-10.85）。与不需要再入院的患者相比，再入院ICU患者的住院死亡率显著更高（17% vs. 3.8%，p=0.025）。识别有再次入住ICU风险的患者应重点关注年龄较大的患者、BMI较高的患者、接受非择期手术的患者、手术时间超过4小时的患者以及术后CNS疾病患者。对这些高危患者进行仔细优化，并在将他们从ICU出院之前谨慎行事，可能有助于降低ICU再入院率、死亡率、住院时间和费用。
The aim of this study was to identify predictors of repeated admission to the intensive care unit (ICU) of patients who underwent cardiac surgery procedures. This retrospective study analyzed 169 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2009 and December 2010. The case group contained 54 patients who were readmitted to the ICU during the same hospitalization and the control group comprised 115 randomly selected patients. Logistic regression analysis revealed that independent predictors for readmission to the ICU after CABG were: older age of patients (odds ratio [OR] 1.04; CI 1.004–1.08); body mass index (BMI) >30 kg/m2 (OR 2.55; CI 1.31–4.97); EuroSCORE II >3.9% (OR 3.56; CI 1.59–7.98); non-elective surgery (OR 2.85; CI 1.37–5.95); duration of operation >4 h (OR 3.44; CI 1.54–7.69); bypass time >103 min (OR 2.5; CI 1.37–4.57); mechanical ventilation >530 min (OR 3.98; CI 1.82–8.7); and postoperative central nervous system (CNS) disorders (OR 3.95; CI 1.44–10.85). The hospital mortality of patients who were readmitted to the ICU was significantly higher compared to the patients who did not require readmission (17% vs. 3.8%, p=0.025). Identification of patients at risk of ICU readmission should focus on older patients, those who have higher BMI, who underwent non-elective surgery, whose operation time was more than 4 hours, and who have postoperative CNS disorders. Careful optimization of these high-risk patients and caution before discharging them from the ICU may help reduce the rate of ICU readmission, mortality, length of stay, and cost.