Institute of Cardiology, Department of Cardiothoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Med Sci Monit. 2013 Feb 28;19:148-52. doi: 10.12659/MSM.883814.
The aim of this study was to identify predictors of repeated admission to the intensive care unit (ICU) of patients who underwent cardiac surgery procedures.
MATERIAL/METHODS: This retrospective study analyzed 169 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2009 and December 2010. The case group contained 54 patients who were readmitted to the ICU during the same hospitalization and the control group comprised 115 randomly selected patients.
Logistic regression analysis revealed that independent predictors for readmission to the ICU after CABG were: older age of patients (odds ratio [OR] 1.04; CI 1.004-1.08); body mass index (BMI)>30 kg/m2 (OR 2.55; CI 1.31-4.97); EuroSCORE II>3.9% (OR 3.56; CI 1.59-7.98); non-elective surgery (OR 2.85; CI 1.37-5.95); duration of operation>4 h (OR 3.44; CI 1.54-7.69); bypass time>103 min (OR 2.5; CI 1.37-4.57); mechanical ventilation>530 min (OR 3.98; CI 1.82-8.7); and postoperative central nervous system (CNS) disorders (OR 3.95; CI 1.44-10.85). The hospital mortality of patients who were readmitted to the ICU was significantly higher compared to the patients who did not require readmission (17% vs. 3.8%, p=0.025).
Identification of patients at risk of ICU readmission should focus on older patients, those who have higher BMI, who underwent non-elective surgery, whose operation time was more than 4 hours, and who have postoperative CNS disorders. Careful optimization of these high-risk patients and caution before discharging them from the ICU may help reduce the rate of ICU readmission, mortality, length of stay, and cost.
本研究旨在确定接受心脏手术的患者再次入住重症监护病房（ICU）的预测因素。
材料/方法：这是一项回顾性研究，分析了 2009 年 1 月至 2010 年 12 月期间接受单纯冠状动脉旁路移植术（CABG）的 169 名患者。病例组包含 54 名在同一住院期间再次入住 ICU 的患者，对照组包含 115 名随机选择的患者。
Logistic 回归分析显示，CABG 后再次入住 ICU 的独立预测因素包括：患者年龄较大（优势比[OR] 1.04；CI 1.004-1.08）；体重指数（BMI）>30 kg/m2（OR 2.55；CI 1.31-4.97）；欧洲危重病评分 II（EuroSCORE II）>3.9%（OR 3.56；CI 1.59-7.98）；非择期手术（OR 2.85；CI 1.37-5.95）；手术时间>4 小时（OR 3.44；CI 1.54-7.69）；旁路时间>103 分钟（OR 2.5；CI 1.37-4.57）；机械通气>530 分钟（OR 3.98；CI 1.82-8.7）；术后中枢神经系统（CNS）障碍（OR 3.95；CI 1.44-10.85）。与不需要再次入住 ICU 的患者相比，再次入住 ICU 的患者的住院死亡率明显更高（17% vs. 3.8%，p=0.025）。
识别 ICU 再次入住的高危患者应侧重于年龄较大、BMI 较高、接受非择期手术、手术时间超过 4 小时以及术后 CNS 障碍的患者。对这些高危患者进行仔细的优化和谨慎的 ICU 出院前评估可能有助于降低 ICU 再次入住率、死亡率、住院时间和成本。
