Becker R B, Zimmerman J E, Knaus W A, Wagner D P, Seneff M G, Draper E A, Higgins T L, Estafanous F G, Loop F D
Department of Anesthesiology, George Washington University Medical Center, Washington, DC 20037, USA.
J Cardiovasc Surg (Torino). 1995 Feb;36(1):1-11.
To identify patient characteristics that are associated with increased ICU length of stay, resource use, and hospital mortality after coronary artery bypass surgery.
Prospective, multicenter study.
Six tertiary care hospitals.
A consecutive sample of 2,435 unselected ICU admissions following coronary artery by-pass surgery.
Demographic, operative characteristics and APACHE III score were collected during the first postoperative day; and APACHE III scores and therapeutic interventions during the first three postoperative days. Hospital survival and ICU length of stay were also recorded. Multivariate equations were derived and cross-validated to predict hospital mortality, ICU length of stay, and ICU resource use.
Unadjusted hospital mortality rate was 3.9% (range 1.0% to 6.0%), mean ICU length of stay was 3.7 days (range 3.2 to 4.7 days), and first 3-day ICU resource use (TISS points) was 99 (range 68 to 116). The range of actual to predicted ICU length of stay varied from 0.86 to 1.26; and resource use from 0.71 to 1.16.
A limited number of operative characteristics, the post-operative acute physiology score (APS) of APACHE III and patient demographic data can predict hospital death rate, ICU length of stay, and resource use immediately following coronary by-pass surgery. These estimates may compliment assessments based on pre-operative risk factors in order to more precisely evaluate and improve the efficacy and efficiency of cardiovascular surgery.
确定与冠状动脉搭桥手术后重症监护病房（ICU）住院时间延长、资源使用增加及医院死亡率升高相关的患者特征。
前瞻性多中心研究。
六家三级护理医院。
冠状动脉搭桥手术后连续入选的2435例未经过筛选的ICU入院患者。
术后第一天收集人口统计学、手术特征及急性生理与慢性健康状况评分系统（APACHE）Ⅲ评分；术后前三天收集APACHEⅢ评分及治疗干预措施。记录医院生存率及ICU住院时间。推导并交叉验证多变量方程以预测医院死亡率、ICU住院时间及ICU资源使用情况。
未经调整的医院死亡率为3.9%（范围1.0%至6.0%），ICU平均住院时间为3.7天（范围3.2至4.7天），ICU前三天资源使用（治疗干预评分系统（TISS）分值）为99分（范围68至116分）。实际与预测的ICU住院时间范围为0.86至1.26；资源使用范围为0.71至1.16。
有限数量的手术特征、APACHEⅢ的术后急性生理学评分（APS）及患者人口统计学数据可预测冠状动脉搭桥手术后的医院死亡率、ICU住院时间及资源使用情况。这些评估可补充基于术前危险因素的评估，以便更精确地评估和提高心血管手术的疗效和效率。
