Key result
Prolonged ICU stay after cardiac surgery is linked to ~47% postdischarge mortality.
Why the study?
Whether hospital discharge alone represents a good outcome for patients who had prolonged intensive care after cardiac surgery was uncertain, prompting evaluation of their postdischarge survival, functional outcome, and ICU resource utilization.
Cohort (n=2,618)
No
Hospital discharge is an incomplete measure of outcome for cardiac surgery patients requiring prolonged intensive care, as many die soon after discharge and survivors often have poor functional capacity.
Discharge survival underestimates mortality and morbidity after prolonged post-cardiac surgery ICU care; leaves open whether targeted interventions improve long-term outcomes.
Objective To determine whether hospital discharge alone represents a good outcome for patients who had prolonged intensive care after cardiac surgery by studying their postdischarge survival and functional outcome. The secondary objective is to estimate the proportion of intensive care unit (ICU) resources used by the long-stay (> or = 10 initial consecutive ICU days) patients and to identify preoperative patient characteristics that are associated with a prolonged ICU stay and hospital and long-term survival. Design Inception cohort study. Setting The Cleveland Clinic Foundation, a tertiary care, academic teaching institution. Patients Cardiac surgery patients with an initial ICU stay of 10 or more consecutive days. Interventions Data were collected daily during hospitalization on every adult who underwent coronary artery bypass graft and/or valve surgery at one institution in 1993. Discharged patients who spent >10 initial consecutive days in the ICU after surgery were contacted by telephone to determine vital status and functional capacity using the Duke Activity Status Index. Total ICU and total hospital direct costs were obtained for each patient. Measurements and main results The primary outcome measurements were ICU length of stay, hospital mortality, after-surgery and postdischarge mortality and functional capacity, and relative resource utilization. Of the 2,618 cardiac surgery patients who met the inclusion criteria, 142 (5.4%) had an initial ICU length of stay of 10 or more consecutive days. Of these, 47 (33.1%) died in the hospital. Ninety-four of the 95 discharged patients were followed up (median follow-up, 30.6 months), and 44 of the 94 (46.8%) died during the follow-up period. The median Duke Activity Status Index for the 50 survivors was 26 out of a possible 58.2. The 142 long-stay patients used 50% of the total ICU days and 48% of the total ICU direct cost for all 2,618 patients. Conclusions Many survivors of prolonged intensive care die soon after hospital discharge and many longer term survivors have a poor functional state. Therefore, hospital discharge is an incomplete measure of outcome for these patients, and longer follow-up is more appropriate. The relatively small number of patients who require prolonged intensive care consumes a disproportionate amount of the total ICU and total hospital direct cost.
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Bashour et al. (2000) conducted a cohort in Cardiac surgery requiring prolonged intensive care (n=2,618). Prolonged ICU stay (>=10 initial consecutive days) vs. ICU stay <10 initial consecutive days was evaluated on ICU length of stay, hospital mortality, postdischarge mortality, functional capacity, and relative resource utilization. Prolonged ICU stay (>=10 days) after cardiac surgery was associated with 33.1% in-hospital mortality, 46.8% postdischarge mortality, and 50% of total ICU days used.
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