Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery in Adults
Abstract
Objective
Prolonged intensive care unit (ICU) stay prevents the use of ICU equipment by other patients and increases hospital cost. This retrospective study aimed to investigate the risk factors for prolonged ICU stay in patients undergoing open heart surgery.
Methods
The medical records of 513 patients who underwent coronary artery bypass grafting and valvular heart surgery were retrospectively evaluated. Patients were divided into two groups based on their ICU stay: groups I (<48 h) and II (≥48 h). The effect of patient variables on the ICU stay duration was investigated using logistic regression analysis.
Results
The mean age of the patients was 61.5±10 years, and 69% were males. The ICU stay of ≥48 h was observed in 20.1% of the patients. Diabetes mellitus and low ejection fraction (pre-operative variables); long aortic cross clamp, cardiopulmonary bypass time and intra-aortic balloon pump requirement (intra-operative variables); arrhythmia, myocardial infarction, renal dysfunction and need for haemodialysis, use of ≥2 inotropic agents, infection, sepsis and respiratory complication (post-operative variables) were found to prolong the ICU stay. In multivariate logistic regression analysis, intra-aortic balloon pump requirement, use of ≥2 inotropic agents, post-operative myocardial infarction and need for haemodialysis were found to be independent risk factors for prolonged ICU stay (p<0.05). Early mortality was 0.97% (5 patients).
Conclusion
Intra-aortic balloon pump requirement, use of ≥2 inotropic agents, post-operative myocardial infarction and need for post-operative haemodialysis are independent risk factors for patients undergoing open heart surgery. Selection of methods for protecting the myocardium and renal functions during the intra-operative period would reduce the duration of ICU stay.