Thorac cardiovasc Surg
DOI: 10.1055/s-0038-1642601
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

ICU Readmission after Cardiac Surgery—Still a Matter of Concern?

Philipp Kolat
1  Department of Cardiovascular Surgery, University Clinics Schleswig-Holstein Campus, Kiel, Germany
,
Patricia Guttenberger
2  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Michael Ried
2  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Julia Kapahnke
2  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Assad Haneya
1  Department of Cardiovascular Surgery, University Clinics Schleswig-Holstein Campus, Kiel, Germany
,
Christof Schmid
2  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Claudius Diez
2  Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

12 June 2017

08 March 2018

Publication Date:
01 May 2018 (online)

Abstract

Background Despite improvements in diagnostics and perioperative care, readmission to intensive care unit (ICU) after cardiac surgery is still a severe drawback for patients with considerable morbidity, mortality, and costs. Aim of this retrospective analysis was to disentangle independent risk factors for ICU readmission.

Material and Methods Between 01/2004 and 12/2012, 336 out of 9,555 (3.5%) patients undergoing cardiac surgery at the Department of Cardiothoracic Surgery in Regensburg (Germany) were readmitted to ICU. A matched-pair analysis (readmission vs control group) was conducted, matching for gender, age, and surgical procedure. Operations included coronary artery bypass grafting, valve reconstruction/replacement, aortic surgery, combined procedures, and others. Mean follow-up was 6.2 ± 2.3 years.

Results Median age of the readmitted patients was 71 years (65; 76), and the majority was male (67.9%). Median logistic Euroscore as a parameter for perioperative risk was significantly higher as compared with the control group (5.8 vs 5.2, p = 0.045) as was the prevalence of comorbidities including hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, stroke, and PAOD. Most common reasons for readmission were cardiopulmonary instability (27.4%), respiratory failure (20.8%), and surgery for deep sternal infection (8.6%). Twenty-one percent required more than one readmission. Overall mortality was significantly higher in readmitted patients (21.1 vs 12.5%).

Conclusions In conclusion, readmission to the ICU after cardiac surgery is a rare complication that is still associated with excessive mortality. Establishment of an intermediate care unit proved to be an excellent means to reduce ICU stay without endangering post-surgery patients and significantly reduced the ICU readmission rate.