Litmathe J, Kurt M, Feindt P, Gams E, Boeken U
Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine University, 40225 Duesseldorf, Germany.
Thorac Cardiovasc Surg. 2009 Oct;57(7):391-4. doi: 10.1055/s-0029-1185852. Epub 2009 Sep 30.
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.
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.
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.
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.
心脏手术后再次入住重症监护病房（ICU）会增加费用，且可能与死亡率升高相关。我们旨在评估ICU再入院的预测因素，并分析这些患者的预后情况。
回顾性分析了2004年至2007年间接受冠状动脉旁路移植术（CABG）和/或瓣膜手术的3523例患者。分析了再入院原因及术后病程。此外，通过多因素回归分析确定再入院的围手术期危险因素。
在从ICU出院的3374例患者中，5.9%（198例）患者需要再次入住重症监护病房（r组）。CABG术后再入院率为4.8%，瓣膜手术±CABG术后再入院率为8.9%（P<0.05）。从ICU出院到再入院的平均间隔时间为3.3±6.2天。未再次入院的患者中，1.3%在医院死亡，而r组为14.4%（P<0.05）。再次入院后，在ICU和医院的平均住院时间分别为7.1±5.9天和21.3±11.1天（所有其他患者为3.1±1.2天和13.1±5.1天[P<0.05]）。再入院的主要原因是呼吸衰竭（59%）、心血管不稳定（25%）、肾衰竭（6.5%）、心脏压塞/出血（6%）、胃肠道并发症（2%）和脓毒症（1.5%）。多因素逻辑回归分析显示，术前肾衰竭、机械通气>24小时、再次手术止血和低心排血量状态是再入院的独立预测因素。
瓣膜/联合手术后的患者更有可能需要再次入住ICU。呼吸并发症是再入院最常见的原因。为降低再入院率，有必要早期治疗心肺问题，尤其是有预测危险因素的患者。
