Yeşiler Fatma İrem, Akmatov Nursultan, Nurumbetova Oktom, Beyazpınar Deniz Sarp, Şahintürk Helin, Gedik Ender, Zeyneloğlu Pınar
Department of Anesthesiology and Critical Care Unit, Baskent University Faculty of Medicine, Ankara, TUR.
Department of Cardiovascular Surgery, Baskent University Faculty of Medicine, Ankara, TUR.
Cureus. 2022 Nov 17;14(11):e31602. doi: 10.7759/cureus.31602. eCollection 2022 Nov.
Open heart surgery (OHS) is frequently performed on elderly patients. We aimed to investigate the risk factors associated with prolonged intensive care unit (ICU) stay in elderly patients undergoing open heart surgery.
Medical records of all patients ≥ 75 years who underwent OHS (coronary artery bypass grafting (CABG) and/or heart valve surgery) between June 1, 2013, and December 31, 2020, were retrospectively analyzed. Those staying in the ICU longer than five days were determined as prolonged ICU stay. Patients were divided into two groups, according to ICU stay <5 days and ≥5 days.
Out of the 198 patients included in the study, 130 (65.7%) were male. Seventy patients (35.4%) had prolonged ICU stay. The mean age was higher in patients within the prolonged ICU stay group when compared to the other group (79.9±3.5 years vs.78.1±2.7 years, p<0.001). The patients who used statins and angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) in the preoperative period had a shorter ICU stay compared to those who did not (45% vs 31.4%, p=0.04; 57% vs 42.9%, p=0.03). The history of previous thoracic surgery (2.3% vs 10% p=0.03), emergency surgery (12.5% vs 24.5% p=0.04), and preoperative pacemaker usage (0.8% vs 7%, 1 p=0.01) were higher in the group of patients with prolonged ICU stay compared to the other group. Preoperative ejection fraction (EF)% (47.7±11.3 vs 51.1±8.8, p<0.001) and hemoglobin level (11.8±1.9 mg/dL vs 12.9±1.6, p<0.001) were lower in the group with prolonged ICU stay compared to the other group. Incidence of cardiac arrest (3.9% vs 15.7% p=0.006), presence of arrhythmia (16.4% vs 41.6%,p<0.001), frequency of pacemaker and intra-aortic balloon pump (IABP) usage (0 vs 10% p=0.002; 1.6% vs 8.6% p=0.02), and need for renal replacement therapy (3.1% vs 12.9%,p=0.02) were higher in the group with prolonged ICU stay compared to the other group. According to the logistic regression analysis; higher age (OR: 1.225, 95%CI 1.104-1.360, p<0.001), preoperative pacemaker usage (OR: 0.100, 95%CI 0.01-0.969, p<0.04), preoperative statin non-use (OR: 2.056, 95%CI 1.040-4.066, p<0.03) and preoperative low EF (OR: 0.947, 95%CI 0.915-0.981, p=0.002) were determined as independent risk factors for prolonged ICU stay.
The incidence of prolonged ICU stay after OHS among patients ≥75 years was 35.4% in our cohort. Higher age, preoperative pacemaker usage, preoperative statin non-use, and low preoperative EF were associated with prolonged ICU stay.
心脏直视手术（OHS）常在老年患者中进行。我们旨在调查老年心脏直视手术患者重症监护病房（ICU）住院时间延长的相关危险因素。
回顾性分析2013年6月1日至2020年12月31日期间所有年龄≥75岁接受OHS（冠状动脉旁路移植术（CABG）和/或心脏瓣膜手术）患者的病历。在ICU住院时间超过5天的患者被确定为ICU住院时间延长。根据ICU住院时间<5天和≥5天将患者分为两组。
纳入研究的198例患者中，130例（65.7%）为男性。70例（35.4%）患者ICU住院时间延长。与另一组相比，ICU住院时间延长组患者的平均年龄更高（79.9±3.5岁对78.1±2.7岁，p<0.001）。术前使用他汀类药物和血管紧张素转换酶抑制剂（ACEi）/血管紧张素受体阻滞剂（ARB）的患者与未使用者相比，ICU住院时间更短（45%对31.4%，p=0.04；57%对42.9%，p=0.03）。与另一组相比，ICU住院时间延长组患者既往胸部手术史（2.3%对10%，p=0.03）、急诊手术（12.5%对24.5%，p=0.04）和术前使用起搏器（0.8%对7%，p=0.01）的比例更高。与另一组相比，ICU住院时间延长组患者术前射血分数（EF）%（47.7±11.3对51.1±8.8，p<0.001）和血红蛋白水平（11.8±1.9mg/dL对12.9±1.6，p<0.001）更低。与另一组相比，ICU住院时间延长组患者心脏骤停发生率（3.9%对15.7%，p=0.006）、心律失常发生率（16.4%对41.6%，p<0.001）、起搏器和主动脉内球囊反搏（IABP）使用频率（0对10%，p=0.002；1.6%对8.6%，p=0.02）以及肾脏替代治疗需求（3.1%对12.9% p=0.02）更高。根据逻辑回归分析；年龄较大（OR：1.225，95%CI 1.104 - 1.360，p<0.001）、术前使用起搏器（OR：0.100，95%CI 0.01 - 0.969，p<0.04）、术前未使用他汀类药物（OR：2.056，95%CI 1.040 - 4.066，p<0.03）和术前EF较低（OR：0.947，95%CI 0.915 - 0.981，p=0.002）被确定为ICU住院时间延长的独立危险因素。
在我们的队列中，≥75岁患者OHS后ICU住院时间延长的发生率为35.4%。年龄较大、术前使用起搏器、术前未使用他汀类药物和术前EF较低与ICU住院时间延长相关。
