Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study.
Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study.
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DOI：
10.1136/bmjopen-2015-010764
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发表时间：
2016-06-08
期刊：
影响因子：
2.9
通讯作者：
Aylin P
中科院分区：
文献类型：
--
作者：
Almashrafi A;Alsabti H;Mukaddirov M;Balan B;Aylin P
本研究设定了两个目标。第一个是确定影响心脏手术后延长术后住院时间（LOS）的因素。第二个是根据入院时可用的术前因素设计心脏重症监护病房 (CICU) 中长期 LOS 的预测模型，并将其与两个现有的心脏分层系统进行比较。观察性回顾性研究。阿曼的一家三级医院。 2009 年至 2013 年间在阿曼一家主要转诊医院接受心脏手术的所有成年患者。30.5% 的患者术后 LOS 延长（≥11 天），而 17% 的患者经历 ICU LOS 延长（≥5 天）。已确定延长 CICU LOS 的因素包括非择期手术、当前充血性心力衰竭 (CHF)、肾衰竭、冠状动脉旁路移植术 (CABG) 和瓣膜手术以及其他非孤立瓣膜或 CABG 手术。根据评分，患者被分为三组。第 1 组、第 2 组和第 3 组延长 CICU LOS 的概率分别为 11%、26% 和 28%。预测模型的曲线下面积为 0.75。与术后总体LOS延长相关的因素包括体重指数、手术类型、体外循环机的使用、浓缩红细胞的使用、非选择性手术和并发症的数量。后者是术后 LOS 最重要的决定因素。患者管理可以根据患者的治疗和个人属性针对个体患者进行定制，以优化资源分配。此外，可以使用大多数医院常规收集的数据开发一个简单的预测评分系统，以识别有长期 CICU 住院风险的患者。
Two objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems. Observational retrospective study. A tertiary hospital in Oman. All adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013. 30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS. Patient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals.