Daniel I McIsaac1,2,3,4,5,6, Bernard McDonald7,8, Coralie A Wong9, Carl van Walraven10,9,11,12. 1. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada. dmcisaac@toh.ca. 2. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada. dmcisaac@toh.ca. 3. Ottawa Hospital Research Institute, Ottawa, Canada. dmcisaac@toh.ca. 4. Institute for Clinical Evaluative Sciences, Toronto, Canada. dmcisaac@toh.ca. 5. School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. dmcisaac@toh.ca. 6. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 1053 Carling Ave, Room B311, Ottawa, ON, K1Y 4E9, Canada. dmcisaac@toh.ca. 7. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada. 8. Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada. 9. Institute for Clinical Evaluative Sciences, Toronto, Canada. 10. Ottawa Hospital Research Institute, Ottawa, Canada. 11. Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada. 12. School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
Abstract
PURPOSE: Most cardiac surgery patients recover well; a substantial minority become critically ill after surgery. The epidemiology of critical illness after cardiac surgery is poorly described. We measured the association of prolonged critical illness with long-term survival and resource use after cardiac surgery. METHODS: This was a historical population-based cohort study in Ontario, Canada (2002-2013), of adult cardiac surgery patients. Validated methods were used to measure postoperative intensive care unit (ICU) length of stay (LOS). We categorized patients into short (0-2 day), moderate (3-9 day), and long (10+ day) ICU LOS groups. The adjusted associations of ICU LOS with one-year survival (primary outcome) and costs, hospital readmissions, and institutional discharge were measured using multilevel, multivariable regression. Pre-specified sensitivity analyses were performed. RESULTS: We included 111,740 patients having their first cardiac surgery during the study period who survived ≥ ten postoperative days. Most patients had a short ICU LOS (75.9%); 20.9% and 3.3% had moderate or long ICU LOS, respectively. The short-stay one-year mortality rate was 2.1%. Longer ICU LOS was independently associated with decreased one-year survival (moderate LOS: hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.6 to 1.94; long LOS: HR, 8.66; 95% CI, 7.93 to 9.44). Sensitivity analyses supported the findings of the primary analysis. Secondary outcomes were independently associated with longer ICU LOS. Long ICU LOS patients occupied 30% of all ICU bed days, and 55% died or were discharged to an institution. CONCLUSION: Prolonged ICU LOS after cardiac surgery is associated with decreased 1-year survival and increased healthcare resource use.
PURPOSE: Most cardiac surgery patients recover well; a substantial minority become critically ill after surgery. The epidemiology of critical illness after cardiac surgery is poorly described. We measured the association of prolonged critical illness with long-term survival and resource use after cardiac surgery. METHODS: This was a historical population-based cohort study in Ontario, Canada (2002-2013), of adult cardiac surgery patients. Validated methods were used to measure postoperative intensive care unit (ICU) length of stay (LOS). We categorized patients into short (0-2 day), moderate (3-9 day), and long (10+ day) ICU LOS groups. The adjusted associations of ICU LOS with one-year survival (primary outcome) and costs, hospital readmissions, and institutional discharge were measured using multilevel, multivariable regression. Pre-specified sensitivity analyses were performed. RESULTS: We included 111,740 patients having their first cardiac surgery during the study period who survived ≥ ten postoperative days. Most patients had a short ICU LOS (75.9%); 20.9% and 3.3% had moderate or long ICU LOS, respectively. The short-stay one-year mortality rate was 2.1%. Longer ICU LOS was independently associated with decreased one-year survival (moderate LOS: hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.6 to 1.94; long LOS: HR, 8.66; 95% CI, 7.93 to 9.44). Sensitivity analyses supported the findings of the primary analysis. Secondary outcomes were independently associated with longer ICU LOS. Long ICU LOS patients occupied 30% of all ICU bed days, and 55% died or were discharged to an institution. CONCLUSION: Prolonged ICU LOS after cardiac surgery is associated with decreased 1-year survival and increased healthcare resource use.
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