Readmission to the Intensive Care Unit in Times of Minimally Invasive Cardiac Surgery: Does Size Matter?
DOI:
https://doi.org/10.1532/HSF98.2014361Abstract
Objectives: It is well known that patients who undergo readmission to an intensive care unit (ICU) after cardiac surgery face an increased risk of morbidity and mortality. The present study sought to evaluate whether less invasive procedures might be associated with a reduction of this economically as well as individually important problem. The role of the quantity of ICU and intermediate care (IMC) beds was investigated as well.
Methods: Altogether, we reviewed 5,333 patients who underwent cardiac surgery in our department between 2005 and 2010. The incidence of and reasons for readmission were determined with regard to individual subgroups, particularly comparing minimally invasive procedures with conventional strategies.
Results: A total of 5,132 patients were primarily discharged from the ICU. Out of this group, 293 patients were readmitted to the ICU at least once. After readmission, the average length of stay in the hospital was 21.9 ± 11.3 days compared to 12.8 ± 5.0 days in all other patients. Comparing the readmission rate in separate years, it was evident that this rate decreased with a growing ICU and IMC capacity. In patients who underwent less invasive cardiac surgery (ie, minimally invasive cardiac surgery, off-pump coronary artery bypass grafting), the readmission rates were significantly lower than in the entirety of patients studied.
Conclusion: Readmission to the ICU after cardiac surgery is associated with impaired outcome. Extended resources in terms of ICU and IMC capacity may positively influence this problem by decreasing the number of readmissions. Modern surgical strategies with less invasive procedures may be associated with a reduced incidence of readmission as well.
References
Bardell T, Legare KJ, Buth GM, Hirsch ISA. 2003. ICU readmission after cardiac surgery. Eur J Cardiothorac Surg 23:354-9.nBucerius J, Gummert JF, Walther T, et al. 2004. Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med 30:88-95.nCelkan MA, Ustunsoy H, Daglar B, Kazaz H, Kocoglu H. 2005. Readmission and mortality in patients undergoing off-pump coronary artery bypass surgery with fast-track recovery protocol. Heart Vessels 20:251-5.nCooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE. 1999. Are readmissions to intensive care unit a useful measure of hospital performance? Med Care 37:399-408.nDaly K, Beale R, Chang RW. 2001. Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model. Br Med J 322:1274-6.nElliot M. 2006. Readmissions to intensive care: a review of the literature. Aust Crit Care 19:86-94.nEngoren M, Arslanian-Engoren C, Steckel D, Neihardt J, Fenn-Buderer N. 2002. Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery. Chest 122:1309-15.nHein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. 2006. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg 81:880-5.nJaber S, Jung B. 2011. Postoperative non-invasive ventilation outside the ICU: do not go too far! Minerva Anestesiol. 77:9-10.nLitmathe J, Kurt M, Feindt P, Gams E, Boeken U. 2009. Predictors and outcome of ICU readmission after cardiac surgery. Thorac Cardiovasc Surg 57:391-4.nMetnitz PG, Fieux F, Jordan B, Lang T, Moreno R, Le Gall JR. 2003. Critically ill patients readmitted to intensive care units-lessons to learn? Intensive Care Med 29:241-8.nNair RU, Sharpe DA. 1998. Minimally invasive reversed Z sternotomy for aortic valve replacement. Ann Thorac Surg 65:1165-6.nPerrotta S, Lentini S. 2009. Ministernotomy approach for surgery of the aortic root and ascending aorta. Interact Cardiovasc Thorac Surg 9:849-58.nPriestap FA, Martin CM. 2006. Impact of intensive care unit discharge time on patient outcome. Crit Care Med 34:2946-51.nRosenberg AL, Hofer TP, Hayward RA, Strachan C, Watts CM. 2001. Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med 29:511-18.nShan KS, Tan CK, Fang CS, Tsai CL, Hou CC, Cheng KC, Lee MC. 2009. Readmission to the intensive care unit: an indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit. Surg Today 39:295-9.nSnow N, Bergin KT, Horrigan TP. 1985. Readmission of patients to the surgical intensive care unit: patient profiles and possibilities for prevention. Crit Care Med 13:961-4.nSociety of Critical Care Medicine. 1988. Guidelines for ICU admission, discharge and triage. SCCM Guidelines US.nWild C, Narath M. 2005. Evaluating and planning ICUs: methods and approaches to differentiate between need and demand. Health policy 71:389-401.n
