Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada.
J Thorac Cardiovasc Surg. 2017 Nov;154(5):1668-1678.e2. doi: 10.1016/j.jtcvs.2017.04.083. Epub 2017 Jul 6.
Octogenarians offered complex cardiac surgery frequently experience a prolonged intensive care unit length of stay; however, minimal data exist on the outcomes of these patients. We sought to determine the rates and predictors of 1-year noninstitutionalized survival ("functional survival") and rehospitalization for octogenarian patients with prolonged intensive care unit length of stay after cardiac surgery and who were discharged from hospital.
The outcomes of discharged patients aged 80 years or more who underwent cardiac surgery with prolonged intensive care unit length of stay (≥5 consecutive days) from January 1, 2000, to December 31, 2011, were examined retrospectively from linked clinical and administrative provincial databases. Regression analysis was used to determine predictors of 1-year functional survival and rehospitalization after discharge from the hospital.
A total of 80 of 683 (11.7%) discharged octogenarian patients had prolonged intensive care unit length of stay. Functional survival at 1 year was 92% and 81% for those with nonprolonged and prolonged intensive care unit lengths of stay, respectively (P < .01). Lack of outpatient physician visits within 30 days of discharge (hazard ratio, 5.18; P < .01) was a significant predictor of poor 1-year functional survival. The 1-year rehospitalization rates were 38% and 48% for those with nonprolonged and prolonged intensive care unit lengths of stay, respectively, with 41% of all rehospitalizations occurring within 30 days of initial discharge. A rural residence (hazard ratio, 1.82; P < .01) and nosocomial pneumonia during patients' operative admissions (hazard ratio, 2.74; P < .01) were associated with rehospitalization within 30 days of discharge.
Octogenarians with prolonged intensive care unit length of stay have acceptable functional survival at 1 year but have high rates of early rehospitalization. Access to health services may influence functional survival and early rehospitalizations. These data suggest that close follow-up of these vulnerable patients after hospital discharge is warranted.
接受复杂心脏手术的 80 岁以上高龄患者通常需要在重症监护病房（ICU）中接受长时间的治疗；然而，关于这些患者的治疗结果，仅有很少的数据。本研究旨在确定接受心脏手术后 ICU 治疗时间延长（≥5 天）并出院的 80 岁以上高龄患者在 1 年内非住院化生存（“功能生存”）和再住院的发生率及其预测因素。
本研究回顾性分析了 2000 年 1 月 1 日至 2011 年 12 月 31 日期间，在省级临床和行政数据库中链接的接受心脏手术且 ICU 治疗时间延长（≥5 天）的 80 岁及以上出院患者的结局。采用回归分析确定出院后 1 年功能生存和再住院的预测因素。
在 683 名出院的 80 岁以上高龄患者中，有 80 名（11.7%）患者 ICU 治疗时间延长。无延长 ICU 治疗时间和延长 ICU 治疗时间的患者分别在 1 年内的功能生存率为 92%和 81%（P<.01）。出院后 30 天内无门诊医生就诊（风险比，5.18；P<.01）是功能生存不良的显著预测因素。无延长 ICU 治疗时间和延长 ICU 治疗时间的患者在 1 年内的再住院率分别为 38%和 48%，所有再住院患者中有 41%在出院后 30 天内发生。农村居民（风险比，1.82；P<.01）和患者手术期间发生医院获得性肺炎（风险比，2.74；P<.01）与出院后 30 天内再住院相关。
接受 ICU 治疗时间延长的 80 岁以上高龄患者在 1 年内具有可接受的功能生存率，但再住院率较高。获得医疗服务的机会可能会影响功能生存和早期再住院率。这些数据表明，这些脆弱患者出院后需要密切随访。
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