Abstract
Background Despite improvements in diagnostics and perioperative care, readmission to intensive
care unit (ICU) after cardiac surgery is still a severe drawback for patients with
considerable morbidity, mortality, and costs. Aim of this retrospective analysis was
to disentangle independent risk factors for ICU readmission.
Material and Methods Between 01/2004 and 12/2012, 336 out of 9,555 (3.5%) patients undergoing cardiac
surgery at the Department of Cardiothoracic Surgery in Regensburg (Germany) were readmitted
to ICU. A matched-pair analysis (readmission vs control group) was conducted, matching
for gender, age, and surgical procedure. Operations included coronary artery bypass
grafting, valve reconstruction/replacement, aortic surgery, combined procedures, and
others. Mean follow-up was 6.2 ± 2.3 years.
Results Median age of the readmitted patients was 71 years (65; 76), and the majority was
male (67.9%). Median logistic Euroscore as a parameter for perioperative risk was
significantly higher as compared with the control group (5.8 vs 5.2, p = 0.045) as was the prevalence of comorbidities including hypertension, chronic obstructive
pulmonary disease, prior myocardial infarction, stroke, and PAOD. Most common reasons
for readmission were cardiopulmonary instability (27.4%), respiratory failure (20.8%),
and surgery for deep sternal infection (8.6%). Twenty-one percent required more than
one readmission. Overall mortality was significantly higher in readmitted patients
(21.1 vs 12.5%).
Conclusions In conclusion, readmission to the ICU after cardiac surgery is a rare complication
that is still associated with excessive mortality. Establishment of an intermediate
care unit proved to be an excellent means to reduce ICU stay without endangering post-surgery
patients and significantly reduced the ICU readmission rate.
Keywords
cardiac - intensive care - outcomes - mortality - morbidity - readmission
