ICU Readmission after Cardiac Surgery—Still a Matter of Concern?
12 June 2017
08 March 2018
01 May 2018 (online)
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.
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