Thorac Cardiovasc Surg 2009; 57(7): 391-394
DOI: 10.1055/s-0029-1185852
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Predictors and Outcome of ICU Readmission after Cardiac Surgery[*]

J. Litmathe1 , M. Kurt1 , P. Feindt1 , E. Gams1 , U. Boeken1
  • 1Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine University, Duesseldorf, Germany
Weitere Informationen

Publikationsverlauf

received February 26, 2009

Publikationsdatum:
30. September 2009 (online)

Abstract

Objective: Readmission to the intensive care unit (ICU) after cardiac surgery is associated with higher costs and may be correlated with an increased mortality. We wanted to evaluate predictors of ICU readmission and to analyze the outcome of those patients. Methods: 3523 patients who underwent CABG and/or valve surgery between 2004 and 2007 were reviewed retrospectively. The reasons for readmission and the postoperative course were analyzed. Furthermore, perioperative risk factors for readmission were determined by multivariate regression analysis. Results: Of the 3374 patients discharged from the ICU, 5.9 % (198) of patients required a second stay in the intensive care (group r). The readmission rate was 4.8 % following CABG and 8.9 % following valve ± CABG (p < 0.05). The mean interval from ICU discharge to readmission was 3.3 ± 6.2 days. Of the patients who were not readmitted, 1.3 % died in hospital, compared to 14.4 % in group r (p < 0.05). After readmission, the mean length of stay in the ICU and in hospital was 7.1 ± 5.9 and 21.3 ± 11.1 days (3.1 ± 1.2 and 13.1 ± 5.1 days for all other patients [p < 0.05]). Main reasons for readmission were respiratory failure (59 %), cardiovascular instability (25 %), renal failure (6.5 %), cardiac tamponade/bleeding (6 %), gastrointestinal complications (2 %) and sepsis (1.5 %). Multivariate logistic regression analysis revealed that preoperative renal failure, mechanical ventilation > 24 h, reexploration for bleeding and low cardiac output state were independent predictors for readmission. Conclusions: Patients after valve/combined surgery are more likely to require readmission to the ICU. Respiratory complications were the most common reasons for readmission. To reduce the readmission rate, it is necessary to treat cardio-respiratory problems early, particularly in patients showing predictive risk factors.

1 This paper was presented in the Main Session “GUCH” at the 38th annual congress of the German Society for Thoracic- and Cardiovascular Surgery on February 16, 2009 in Stuttgart.

References

  • 1 Kalmar P, Irrgang E. Cardiac surgery in Germany during 2000: a report by the German Society for Thoracic and Cardiovascular Surgery.  Thorac Cardiovasc Surg. 2001;  49 33-38
  • 2 Kalmar P, Irrgang E. Cardiac surgery in Germany during 2003: a report by the German Society for Thoracic and Cardiovascular Surgery.  Thorac Cardiovasc Surg. 2004;  52 312-317
  • 3 Engoren M, Arslanian-Engoren C, Steckel D, Neihardt J, Fenn-Buderer N. Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery.  Chest. 2002;  122 1309-1315
  • 4 Society of Critical Care Medicine .Guidelines for ICU admission, discharge and triage. SCCM Guidelines. Mount Prospect Illinois, US; SCCM 1988
  • 5 Snow N, Bergin K T, Horrigan T P. Readmission of patients to the surgical intensive care unit: patient profiles and possibilities for prevention.  Crit Care Med. 1985;  13 961-964
  • 6 Elliot M. Readmissions to intensive care: a review of the literature.  Aust Crit Care. 2006;  19 86-94
  • 7 Rosenberg A L, Hofer T P, Hayward R A, Strachan C, Watts C M. Who bounces back? Physiologic and other predictors of intensive care unit readmission.  Crit Care Med. 2001;  29 511-518
  • 8 Daly K, Beale R, Chang R W. Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model.  Br Med J. 2001;  322 1274-1276
  • 9 Priestap F A, Martin C M. Impact of intensive care unit discharge time on patient outcome.  Crit Care Med. 2006;  34 2946-2951
  • 10 Cooper G S, Sirio C A, Rotondi A J, Shepardson L B, Rosenthal G E. Are readmissions to intensive care unit a useful measure of hospital performance?.  Med Care. 1999;  37 399-408
  • 11 Chen L M, Martin C M, Keenan S P, Sibbald W J. Patients readmitted to intensive care unit during the same hospitalization: clinical features and outcomes.  Crit Care Med. 1998;  26 1834-1841
  • 12 Bardell T, Legare K J, Buth G M, Hirsch I S A. ICU readmission after cardiac surgery.  Eur J Cardiothorac Surg. 2003;  23 354-359
  • 13 Conlon N, O'Brien B, Herbison G P, Marsh B. Long term functional outcome and performance status after intensive care unit readmission: a prospective study.  Br J Anaesth. 2008;  100 219-223
  • 14 Finkielman J D, Morales I J, Peters S G, Keegan M T, Ensminger S A, Lymp J F, Afessa B. Mortality rate and length of stay of patients admitted to the intensive care unit in July.  Crit Care Med. 2004;  32 1161-1165
  • 15 Svircevic V, Nierich A P, Moons K G, Brandon Bravo Bruinsma G J, Kalkman C J, van Dijk D. Fast track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients.  Anesth Analg. 2009;  108 689-691

1 This paper was presented in the Main Session “GUCH” at the 38th annual congress of the German Society for Thoracic- and Cardiovascular Surgery on February 16, 2009 in Stuttgart.

Dr. Jens Litmathe

Department of Thoracic and Cardiovascular Surgery
Heinrich-Heine University

Moorenstrasse 5

40225 Duesseldorf

Germany

Telefon: + 49 17 32 73 86 81

Fax: + 49 21 18 11 83 33

eMail: jens-litmathe@t-online.de