Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
University of Virginia School of Medicine, Charlottesville, Virginia.
Ann Thorac Surg. 2023 May;115(5):1297-1303. doi: 10.1016/j.athoracsur.2023.01.025. Epub 2023 Feb 3.
Cardiac postoperative intensive care unit (ICU) beds are a limited resource, and when a patient no longer requires this level of care they are quickly transferred out. We hypothesized that complications and ICU readmission increased when transfer occurred during off-hours compared with regular work hours.
From 2010 to 2021, patients who underwent a Society of Thoracic Surgeons index operation at a single center were assigned a group based on their ICU transfer time, defined as when they physically arrived on the acute care floor. Patients were stratified into off-hours vs regular hours by their transfer time. Off-hours was defined as 9 pm to 5 am. Risk-adjusted multivariable logistic regression analyzed the association of ICU readmission, postoperative complications, operative mortality, and failure to rescue by group.
The cohort included 5951 patients (off-hours n = 292 [4.9%], regular-hours n = 5659 [95.1%]). Patients in the off-hours group had significantly greater odds of risk-adjusted ICU readmission (odds ratio 1.99, 95% CI 1.25-3.04, P < .002) and mortality (odds ratio 3.88, 95% CI 2.27-6.33, P < .001). In the major complications subgroup (Off-hours n = 55, Regular-hours n = 603), Off-hours transfer was associated with increased mortality (failure to rescue) (odds ratio 3.05, 95% CI 1.58-5.69, P = .001).
Off-hours ICU to floor transfer was associated with increased postoperative complications, ICU readmission, and mortality, suggesting that the timing of ICU transfer may impact outcomes. This elucidates targets for quality and process improvement for our center and others facing the same resource constraints.
心脏术后重症监护病房（ICU）床位是一种有限的资源，当患者不再需要这种级别的护理时，他们会被迅速转出。我们假设与常规工作时间相比，在非工作时间转移会增加并发症和 ICU 再入院的风险。
从 2010 年至 2021 年，在一家单中心接受胸外科协会指数手术的患者根据 ICU 转移时间被分为两组，定义为患者实际到达急性护理楼层的时间。根据转移时间将患者分为非工作时间组和常规工作时间组。非工作时间定义为晚上 9 点至早上 5 点。采用风险调整多变量逻辑回归分析两组 ICU 再入院、术后并发症、手术死亡率和救援失败的相关性。
该队列纳入了 5951 名患者（非工作时间组 n=292[4.9%]，常规工作时间组 n=5659[95.1%]）。非工作时间组的患者 ICU 再入院风险调整比值比（OR）显著增加（OR 1.99，95% CI 1.25-3.04，P<.002）和死亡率（OR 3.88，95% CI 2.27-6.33，P<.001）。在主要并发症亚组（非工作时间组 n=55，常规工作时间组 n=603）中，非工作时间转移与死亡率（救援失败）增加相关（OR 3.05，95% CI 1.58-5.69，P=.001）。
非工作时间 ICU 到病房的转移与术后并发症、ICU 再入院和死亡率增加相关，这表明 ICU 转移的时间可能会影响结局。这为我们中心和其他面临同样资源限制的中心确定了质量和流程改进的目标。
