Exploring Recidivism in Cardiac Surgical ICU: Can this Understanding Translate to Enhanced Patient Outcomes?

IF 1.1 Q3 ANESTHESIOLOGY
Annals of Cardiac Anaesthesia Pub Date : 2024-10-01 Epub Date: 2024-10-04 DOI:10.4103/aca.aca_68_24
Raj Sahajanandan, A V Varsha, Vinay M Rao, Ben B Kurien, Korah Kuruvilla, Roy Thankachen, Madhu A Philip
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引用次数: 0

Abstract

Objective: The need for reinstitution of intensive care unit (ICU) care ("recidivism") in post-cardiac surgery patients is associated with increased morbidity, mortality, resource use, and healthcare costs. Recidivism is propounded as a quality indicator of ICU care. There is a paucity of studies from India regarding cardiac surgical ICU readmissions, their outcomes, and risk factors.

Methods: Nested case-control study including 1,711 consecutive adult patients who underwent cardiac surgery over a two-year period at a tertiary care institute. The patients were grouped into recidival (R) and control (C) groups. The reasons for readmission, outcomes, and predictive risk factors were analyzed.

Results: Fifty-four of 1,711 (3.1%) patients were readmitted to ICU, main reasons being cardiac arrhythmias (24, 41%), pericardial effusion (9, 15.2%), and infection (8, 13.5%). Readmission was significantly higher for valvular interventions (39 patients, 24.3%, mitral valve 25 patients) than coronary artery bypass grafting (13, 10.6%), P value 0.003*. On multivariate analysis, EuroSCORE 2 (>5), age, surgical reexploration, postoperative pulmonary complications, and infections were independently associated with a need for ICU readmission. The mortality rate among the readmitted patients was 7.4% compared to 1.4% overall mortality. The mean total postoperative length of stay was significantly longer for recidival patients (17.6 ± 14 days vs 7.6 ± 2.4 days; P < 0.0001).

Conclusions: Recidivism is associated with longer hospital stay, suboptimal outcomes as well higher risk of mortality. Postoperative cardiac dysrhythmia was the most common cause of recidivism in our cohort. Early identification of patients at risk for recidivism and timely management of cardiopulmonary complications can translate to better outcomes.

探索心脏外科重症监护室中的累犯问题:这种理解能否改善患者的治疗效果?
目的:心脏手术后患者需要恢复重症监护室(ICU)护理("再犯")与发病率、死亡率、资源使用和医疗成本的增加有关。再犯率被认为是重症监护室护理的质量指标。印度有关心脏外科重症监护室再入院、其结果和风险因素的研究很少:方法: 嵌套病例对照研究,包括 1711 名连续两年在一家三级医疗机构接受心脏手术的成年患者。患者被分为再入院组(R)和对照组(C)。对再入院的原因、结果和预测风险因素进行了分析:结果:1,711 名患者中有 54 人(3.1%)再次入住重症监护室,主要原因是心律失常(24 人,41%)、心包积液(9 人,15.2%)和感染(8 人,13.5%)。瓣膜介入治疗的再入院率(39 例,24.3%,二尖瓣 25 例)明显高于冠状动脉旁路移植术(13 例,10.6%),P 值为 0.003*。在多变量分析中,EuroSCORE 2(>5)、年龄、手术再探查、术后肺部并发症和感染与重症监护室再入院的需求独立相关。再入院患者的死亡率为 7.4%,而总死亡率为 1.4%。累犯患者的平均术后总住院时间明显更长(17.6 ± 14 天 vs 7.6 ± 2.4 天;P < 0.0001):结论:累犯与住院时间更长、治疗效果不理想以及更高的死亡风险有关。在我们的队列中,术后心律失常是导致再犯的最常见原因。及早识别有再犯风险的患者并及时处理心肺并发症,可获得更好的治疗效果。
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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
147
审稿时长
26 weeks
期刊介绍: Annals of Cardiac Anaesthesia (ACA) is the official journal of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. The journal is indexed with PubMed/MEDLINE, Excerpta Medica/EMBASE, IndMed and MedInd. The journal’s full text is online at www.annals.in. With the aim of faster and better dissemination of knowledge, we will be publishing articles ‘Ahead of Print’ immediately on acceptance. In addition, the journal would allow free access (Open Access) to its contents, which is likely to attract more readers and citations to articles published in ACA. Authors do not have to pay for submission, processing or publication of articles in ACA.
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