Relationship Between Intensive Care Unit Length of Stay and One-Year Mortality Following Cardiac Surgery

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-04-06 DOI:10.1155/jocs/6654088

Gregory A. Panza, Raymond G. McKay, Susan Collazo, Deborah Loya, Carolyn Burke-Martindale, Jeffrey F. Mather, Sabet W. Hashim

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Abstract

Background: Prolonged intensive care unit (ICU) length of stay (LOS) following cardiac surgery has been associated with higher resource utilization and increased in-hospital mortality. Few reports have investigated the association between prolonged ICU LOS and subsequent mortality following hospital discharge.

Methods: The relationship between ICU LOS and 1-year all-cause mortality was assessed in 2799 patients treated with coronary artery bypass grafting with and without concomitant valve surgery at a large tertiary center between January 1, 2017, and December 31, 2021. Multivariable logistic regression and Cox proportional hazards regression examined ICU LOS as a predictor of 1-year mortality and to define the risk of mortality for ICU stays ranging from < 4 to > 14 days.

Results: Patients (N = 2799) included 76.1% males and 23.9% females aged 67.9 ± 9.9 years. Surgeries included isolated CABG (76.9%) and CABG with valve surgery (23.1%). Patients had a median ICU LOS of 1.93 days (IQR = 2.71), and 92 patients (3.3%) expired within 1 year of hospital discharge. ICU LOS was a significant predictor of 1-year mortality (OR = 1.09, 95% CI = 1.06, 1.12, p < 0.001), while controlling for significant covariates. The prevalence of 1-year all-cause mortality progressively increased by ICU LOS cutoffs: < 4 days (1.9%), ≥ 4 days (7.2%), > 7 days (17.5%), and > 14 days (31.9%). Survival analysis further indicated that 1-year mortality risk increased by ICU LOS cutoffs: ≥ 4 days (HR = 1.88, 95% CI = 1.19, 2.98, p = 0.007), > 7 days (HR = 3.80, 95% CI = 2.31, 6.25, p < 0.001), and > 14 days (HR = 10.15, 95% CI = 5.64, 18.25, p < 0.001).

Conclusions: For each additional ICU day following CABG with and without valve surgery, the odds of 1-year mortality increased by 9.0% when controlling for significant covariates. The risk of 1-year all-cause mortality increased by 88%, 280%, and 915% for ICU LOS ≥ 4 days, > 7 days, and > 14 days, respectively. These data indicate the need for more frequent postdischarge medical surveillance in patients with prolonged ICU stay.

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心脏手术后重症监护病房住院时间与1年死亡率的关系

背景：心脏手术后延长重症监护病房（ICU）住院时间（LOS）与较高的资源利用率和住院死亡率增加有关。很少有报道调查延长ICU LOS与出院后死亡率之间的关系。方法：对2017年1月1日至2021年12月31日在一家大型三级中心接受冠状动脉搭桥术和不合并瓣膜手术治疗的2799例患者进行ICU LOS与1年全因死亡率的关系进行评估。多变量logistic回归和Cox比例风险回归检验了ICU LOS作为1年死亡率的预测因子，并确定了ICU住院期间的死亡率风险，范围从<；4到>；14天。结果：患者2799例，男性76.1%，女性23.9%，年龄67.9±9.9岁。手术包括单独冠脉搭桥（76.9%）和冠脉搭桥合并瓣膜手术（23.1%）。ICU住院时间中位数为1.93天（IQR = 2.71），出院1年内死亡92例（3.3%）。ICU LOS是1年死亡率的重要预测因子(OR = 1.09, 95% CI = 1.06, 1.12, p <；0.001)，同时控制显著协变量。1年全因死亡率随ICU LOS截止时间的增加而逐渐增加：<；4天（1.9%），≥4天（7.2%），>；7天（17.5%），>；14天（31.9%）。生存分析进一步表明，ICU LOS截止时间≥4天，1年死亡风险增加（HR = 1.88, 95% CI = 1.19, 2.98, p = 0.007）；7天(HR = 3.80, 95% CI = 2.31, 6.25, p <；0.001), >；14天(HR = 10.15, 95% CI = 5.64, 18.25, p & lt;0.001)。结论：在控制重要协变量的情况下，CABG合并或不合并瓣膜手术后每增加1天ICU， 1年死亡率增加9.0%。ICU住院时间≥4天的患者1年全因死亡风险分别增加88%、280%和915%；7天，>；分别是14天。这些数据表明，需要更频繁的出院后医学监测的患者延长ICU住院时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.