Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital Foundation Trust, Manchester, UK.
Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital Foundation Trust, Manchester, UK; Department of Cardiothoracic Anaesthesia and Critical Care, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK.
J Cardiothorac Vasc Anesth. 2021 Jul;35(7):2166-2179. doi: 10.1053/j.jvca.2021.02.056. Epub 2021 Mar 1.
Readmission to the cardiac intensive care unit after cardiac surgery has significant implications for both patients and healthcare providers. Identifying patients at risk of readmission potentially could improve outcomes. The objective of this systematic review was to identify risk factors and clinical prediction models for readmission within a single hospitalization to intensive care after cardiac surgery. PubMed, MEDLINE, and EMBASE databases were searched to identify candidate articles. Only studies that used multivariate analyses to identify independent predictors were included. There were 25 studies and five risk prediction models identified. The overall rate of readmission pooled across the included studies was 4.9%. In all 25 studies, in-hospital mortality and duration of hospital stay were higher in patients who experienced readmission. Recurring predictors for readmission were preoperative renal failure, age >70, diabetes, chronic obstructive pulmonary disease, preoperative left ventricular ejection fraction <30%, type and urgency of surgery, prolonged cardiopulmonary bypass time, prolonged postoperative ventilation, postoperative anemia, and neurologic dysfunction. The majority of readmissions occurred due to respiratory and cardiac complications. Four models were identified for predicting readmission, with one external validation study. As all models developed to date had limitations, further work on larger datasets is required to develop clinically useful models to identify patients at risk of readmission to the cardiac intensive care unit after cardiac surgery.
心脏手术后再次入住心脏重症监护病房对患者和医疗保健提供者都有重大影响。识别有再次入院风险的患者可能会改善预后。本系统评价的目的是确定心脏手术后单一住院期间再次入住重症监护病房的风险因素和临床预测模型。检索了 PubMed、MEDLINE 和 EMBASE 数据库以确定候选文章。仅纳入使用多变量分析确定独立预测因素的研究。共确定了 25 项研究和 5 个风险预测模型。纳入研究的总体再入院率为 4.9%。在所有 25 项研究中，再次入院的患者住院死亡率和住院时间均较高。再入院的反复出现的预测因素包括术前肾功能衰竭、年龄>70 岁、糖尿病、慢性阻塞性肺疾病、术前左心室射血分数<30%、手术类型和紧急程度、体外循环时间延长、术后通气时间延长、术后贫血和神经功能障碍。大多数再入院是由于呼吸和心脏并发症引起的。确定了 4 个预测再入院的模型，其中有 1 个外部验证研究。由于迄今为止开发的所有模型都存在局限性，因此需要在更大的数据集上进一步开展工作，以开发出用于识别心脏手术后有再次入住心脏重症监护病房风险的患者的临床有用模型。
