Department of Nursing, National Taiwan University Hospital, Taiwan; School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
J Formos Med Assoc. 2022 Jan;121(1 Pt 2):304-313. doi: 10.1016/j.jfma.2021.04.020. Epub 2021 May 24.
BACKGROUND/PURPOSE: Monitoring ICU length of stay (LOS) after CABG and examining its risk factors can guide initiatives on the improvement of care. But few have evaluated this issue to include personal and clinical factors, and demands of ICU care. This study applied Donabedian model to identify risk factors for longer ICU stays after CABG. Lifestyle, clinical factors during and after CABG, TISS were viewed as structure factors, and infection and organ failures during ICU did as process factors.
This retrospective cohort study used data via medical records at a medical center. A stratified randomized sample of 230 adults from a cohort of 690 isolated CABGs was to reflect the rate of 34.7% longer than 3-day-ICU LOS. The sample comprised of longer-stay group (n = 150) and shorter-stay group (n = 80).
Hierarchical logistic regression analysis revealed that potential signs of infection (3-day average WBC higher than 10,000/μL, OR: 3.41 and the body temperature higher than 38 °C, OR:5.67) and acute renal failure (OR: 8.97) remained as the most significant predicted factors of stay longer than 3 ICU days. Along with higher TISS score within 24 hours (OR:1.06), structure factors of female gender (OR:4.16) smoking(OR: 4.87), higher CCI before surgery(OR:1.49), bypass during CABG (OR:3.51) had higher odds of risk to stay longer.
Further quality improvement initiatives to shorten ICU stay after CABG may include the promotion of a smoking cessation program in clinical practice, and better management of the manpower allocation, infection control and renal failure.
背景/目的：监测冠状动脉旁路移植术（CABG）后 ICU 住院时间（LOS）并检查其危险因素可以指导改善护理的措施。但很少有人评估这个问题，包括个人和临床因素以及 ICU 护理的需求。本研究应用 Donabedian 模型来确定 CABG 后 ICU 住院时间延长的危险因素。生活方式、CABG 期间和之后的临床因素、TISS 被视为结构因素，而 ICU 期间和之后的感染和器官衰竭被视为过程因素。
这是一项回顾性队列研究，使用医疗中心的病历数据。从 690 例孤立性 CABG 队列中分层随机抽取 230 名成年人作为样本，以反映 3 天以上 ICU LOS 的比例为 34.7%。该样本包括较长住院时间组（n = 150）和较短住院时间组（n = 80）。
分层逻辑回归分析显示，潜在感染迹象（3 天平均白细胞计数高于 10,000/μL，OR：3.41；体温高于 38°C，OR：5.67）和急性肾衰竭（OR：8.97）仍然是住院时间超过 3 天的最重要预测因素。此外，24 小时内 TISS 评分较高（OR：1.06）、结构因素中女性（OR：4.16）、吸烟（OR：4.87）、手术前 CCI 较高（OR：1.49）、CABG 期间旁路（OR：3.51）的风险更高，住院时间更长。
进一步缩短 CABG 后 ICU 住院时间的质量改进措施可能包括在临床实践中推广戒烟计划，以及更好地管理人力配置、感染控制和肾衰竭。
