Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation

Authors

  • Fevzi Toraman
  • Sahin Senay
  • Umit Gullu
  • Hasan Karabulut
  • Cem Alhan

DOI:

https://doi.org/10.1532/HSF98.20101009

Abstract

Introduction: In the present study, we investigated risk factors for intensive care unit (ICU) readmission after fasttrack cardiac surgery and analyzed outcome data according to the type of surgical procedure.

Methods: Between 1999 and 2008, we prospectively enrolled 4270 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) (CABG group, n = 3754), isolated valve surgery (valve group, n = 353), or combined CABG and valve surgery (CABG + valve group, n = 163) in the study.

Results: Ninety-eight patients (2.2%) were readmitted to the ICU. Of these patients, 73 were in the CABG group (1.9% of this group), 16 were in the valve group (4.5%), and 9 were in the CABG + valve group (5.5%). The main reason for ICU readmission in all groups was respiratory distress. A multivariate analysis showed that the independent risk factors for ICU readmission in the CABG group were an age >65 years (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5-5.4; P = .001), peripheral arterial disease (OR, 2.7; 95% CI, 1.2-6.1; P = .016), and drainage >500 mL (OR, 2.5; 95% CI, 1.2-5.1; P = .009). The independent risk factors for the valve group included only preoperative congestive heart failure (OR, 3.9; 95% CI, 1.3-11.7; P = .01). No independent risk factor was defined for the CABG + valve group. Mortality was significantly higher among the readmitted patients in all groups.

Conclusions: The risk factors for readmission after cardiac surgery with fast-track recovery may differ according to the type of operation. A strict control of volume balance and blood transfusion may further help prevent the occurrence of the most frequent cause of readmission, respiratory failure.

References

Alhan C, Toraman F, Karabulut EH, et al. 2003. Fast track recovery of high risk coronary bypass surgery patients. Eur J Cardiothorac Surg 23:678-83.nBardell T, Legare JF, Buth KJ, Hirsch GM, Ali IS. 2003. ICU readmission after cardiac surgery. Eur J Cardiothorac Surg 23:354-9.nCapdeville M, Lee JH, Taylor AL. 2001. Effect of gender on fast-track recovery after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 15:146-51.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.nCheng DC. 1998. Fast-track cardiac surgery: economic implications in postoperative care. J Cardiothorac Vasc Anesth 12:72-9.nCohn WE, Selke FW, Sirois C, Lisbon A, Johnson RG. 1999. Surgical ICU recidivism after cardiac operations. Chest 116:688-92.nEngelman RM, Rousou JA, Flack JE 3rd, et al. 1994. Fast track recovery of the coronary bypass patient. Ann Thorac Surg 58:1742-6.nHiggins TL. 1992. Early endotracheal extubation is preferable to late extubation in patients following coronary artery surgery. J Cardiothorac Anesth 6:488-93.nHiggins TL. 1995. Safety issues regarding early extubation after coronary artery bypass surgery. J Cardiothorac Vasc Anesth 9:24-9.nKarski JM. 1995. Practical aspects of early extubation in cardiac surgery. Cardiothorac Vasc Anesth 9:30-3.nKogan A, Cohen J, Raanani E, et al. 2003. Readmission to the intensive care unit after "fast-track" cardiac surgery: risk factors and outcomes. Ann Thorac Surg 76:503-7.nKonstantakos AK, Lee J. 2000. Optimizing timing of early extubation in coronary artery bypass surgery patients. Ann Thorac Surg 69:1842-5.nKuduvalli M, Oo AY, Newall N, et al. 2005. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg 27:592-8.nLazar HL, Fitzgerald CA, Ahmad T, et al. 2001. Early discharge after coronary artery bypass graft surgery: are patients really going home earlier? J Thorac Cardiovasc Surg 121:943-50.nMarquez J, Macgovern J, Kaplan P, Sakert T, Gravlee GP. 1995. Cardiac surgery "fast tracking" in an academic hospital. J Cardiothorac Vasc Anesth 9:34-6.nRosenberg AL, Watts C. 2000. Patients readmitted to the ICUs: a systematic review of risk factors and outcomes. Chest 118:492-502.nSenay S, Toraman F, Gunaydin S, Kilercik M, Karbulut H, Alhan C. 2009. The impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study. Interact Cardiovasc Thorac Surg 8:93-9.nSurgenor SD, DeFoe GR, Fillinger MP, et al. 2006. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation 114:I43-8.nToraman F, Evrenkaya S, Yuce M, et al. 2004. Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome. Perfusion 19:85-91.nToraman F, Evrenkaya S, Yuce M, Goksel O, Karabulut H, Alhan C. 2005. Fast-track recovery in noncoronary cardiac surgery patients. Heart Surg Forum 8:E61-4.n

Published

2010-08-18

How to Cite

Toraman, F., Senay, S., Gullu, U., Karabulut, H., & Alhan, C. (2010). Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation. The Heart Surgery Forum, 13(4), E212-E217. https://doi.org/10.1532/HSF98.20101009

Issue

Section

Articles