Jarząbek Radosław, Bugajski Paweł, Greberski Krzysztof, Błaszczyński Jerzy, Słowińska-Jarząbek Barbara, Kalawski Ryszard
Oddział Kardiochirurgii, Wielospecjalistyczny Szpital Miejski im. Józefa Strusia, Poznań.
Kardiol Pol. 2014;72(8):740-7. doi: 10.5603/KP.a2014.0062. Epub 2014 Mar 27.
Intensive care unit (ICU) readmission after cardiac surgery is believed to be associated with higher in-hospital mortality and may predict poor outcomes. ICU readmissions use resources and increase treatment costs.
To determine reasons for readmission to ICU, evaluate outcomes in these patients, and identify factors predisposing to the need for readmission to ICU.
We retrospectively investigated a total of 2076 consecutive adult patients who underwent either isolated coronary artery bypass grafting or a valve procedure or combination of both and were discharged from our ICU between January 2008 and December 2010. To identify the factors that increase the risk of readmission to ICU, we used the dominance-based rough set approach (DRSA) which is a methodology of knowledge discovery from data. The knowledge has the form of "if... then..." decision rules relating patient characteristics to the risk of readmission to ICU.
Of 2076 patients discharged from ICU, 56 (2.7%) required a second stay in the ICU (study group) while 2020 patients needed no readmission to ICU (control group). The main causes of readmission were haemodynamic instability (28.6%, n = 16), respiratory failure (23.2%, n = 13), and cardiac tamponade or bleeding (23.2%, n = 13). The mean length of stay (LOS) in the general cardiac ward after primary discharge from ICU until readmission was 3.5 ± 4.2 days. The mean LOS in ICU after readmission was 12.5 ± 21.2 days. Postoperative complications occurred more frequently in readmitted patients (10.2% vs. 48.2%, p < 0.0001). In-hospital mortality was significantly higher in the study group (15 [26.8%] vs. 23 [1.1%] patients, p < 0.0001). As a result of applying the DRSA methodology, the algorithm generated decision rules categorizing patients into high and low ICU readmission risk. Advanced age, non-elective surgery and the length of initial ICU stay after the surgery were the factors of greatest importance for the correct categorisation of patients in the study group.
The most common cause of readmission to ICU is haemodynamic instability. Postoperative complication and in-hospital mortality rates are significantly higher in patients readmitted to ICU. Factors most commonly predisposing to readmission to ICU after cardiac surgery included advanced patient age, non-elective surgery, and longer initial stay in ICU after the surgery.
心脏手术后重症监护病房（ICU）再入院被认为与较高的院内死亡率相关，并且可能预示不良预后。ICU再入院会消耗资源并增加治疗成本。
确定ICU再入院的原因，评估这些患者的预后，并识别易导致ICU再入院的因素。
我们回顾性调查了2008年1月至2010年12月期间在我院ICU接受单纯冠状动脉旁路移植术、瓣膜手术或两者联合手术并出院的2076例连续成年患者。为了识别增加ICU再入院风险的因素，我们使用了基于优势关系的粗糙集方法（DRSA），这是一种从数据中发现知识的方法。这些知识具有“如果……那么……”决策规则的形式，将患者特征与ICU再入院风险相关联。
在从ICU出院的2076例患者中，56例（2.7%）需要再次入住ICU（研究组），而2020例患者无需再次入住ICU（对照组）。再入院的主要原因是血流动力学不稳定（28.6%，n = 16）、呼吸衰竭（23.2%，n = 13）以及心包填塞或出血（23.2%，n = 13）。从ICU首次出院至再入院期间在普通心脏病房的平均住院时间为3.5±4.2天。再入院后在ICU的平均住院时间为12.5±21.2天。再入院患者术后并发症的发生率更高（10.2%对48.2%，p < 0.0001）。研究组的院内死亡率显著更高（15例[26.8%]对23例[1.1%]患者，p < 0.0001）。应用DRSA方法的结果是，该算法生成了将患者分为ICU再入院高风险和低风险的决策规则。高龄、非择期手术以及术后初始ICU住院时间是研究组患者正确分类最重要的因素。
ICU再入院最常见的原因是血流动力学不稳定。再次入住ICU的患者术后并发症和院内死亡率显著更高。心脏手术后最常导致ICU再入院有因素包括患者高龄、非择期手术以及术后在ICU的初始住院时间较长。
