AHEAD Score and Prolonged Intensive Care Unit Stay Following Isolated Coronary Artery Bypass Grafting

Q: What are the key findings of this study?

Each 1-point increase in the preoperative AHEAD score independently predicted a higher risk of prolonged ICU stay (>72 hours) following isolated CABG (adjusted OR 1.620, 95% CI 1.317-1.993, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Isolated coronary artery bypass grafting (CABG) (n=518). Intervention: Preoperative AHEAD score (per 1-point increase) vs. Lower AHEAD score (or score of 0 in categorical analysis). Primary outcome: Prolonged postoperative intensive care unit (ICU) stay (>72 hours) (OR 1.620, 95% CI 1.317-1.993, p=<0.001).

Q: What does this research mean for the field?

Higher preoperative AHEAD scores independently predict an increased risk of prolonged intensive care unit stay following isolated coronary artery bypass grafting. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Büşra Güvendi Şengör; Mehmet Şengör; Muhammet Mücahit Tiryaki; Faruk Akalin; Kadir Bıyıklı; Mustafa Ferhat Keten; Cemalettin Yılmaz; ÜNAL AYDIN; Regayip ZEHİR

doi:10.14235/bas.galenos.2026.76743

October 26, 2026Bezmialem ScienceOpen Access

AHEAD Score and Prolonged Intensive Care Unit Stay Following Isolated Coronary Artery Bypass Grafting

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Key result

AHEAD score linked to ~62% higher odds of prolonged ICU stay post-CABG per point.

OR 1.620
95% CI 1.317-1.993
P<0.001
n=518

Why the study?

Prolonged postoperative ICU stay after CABG is associated with unfavorable clinical outcomes and increased healthcare resource utilization. Although the AHEAD score predicts adverse outcomes in several cardiovascular conditions, whether it can predict prolonged ICU stay following isolated CABG remained to be evaluated.

Does a higher preoperative AHEAD score predict prolonged intensive care unit stay (>72 hours) in patients undergoing isolated coronary artery bypass grafting?

Key Points

To assess whether the preoperatively assessed AHEAD score can predict prolonged intensive care unit stay following isolated coronary artery bypass grafting.
Retrospective two-center study analyzing data from 518 consecutive patients undergoing isolated coronary artery bypass grafting between January 2020 and September 2025.
AHEAD score components (atrial fibrillation, low hemoglobin level, elderly age, abnormal renal function, and diabetes mellitus) were analyzed as a continuous variable and categorized into 0, 1, 2, and ≥3 points.
Prolonged intensive care unit stay was defined as duration exceeding 72 hours (>3 days).
Prolonged intensive care unit stay occurred in 143 of 518 patients (27.6%), who had significantly higher median AHEAD scores than those without prolonged stays [2 (1-3) vs. 1 (0-2), p<0.001].

Study Design

Type

Cohort (n=518)

Multicenter

Yes

Structured PICO

Does a higher preoperative AHEAD score predict prolonged intensive care unit stay (>72 hours) in patients undergoing isolated coronary artery bypass grafting?

P

Population

518 patients (median age 62 years, 20.1% female) undergoing elective isolated coronary artery bypass grafting at two referral centers in Turkey, followed through hospital discharge (median stay 10 days).

E

Exposure

Preoperative AHEAD score assessment (0 to 5 points based on atrial fibrillation, hemoglobin <13 g/dL in men and <12 g/dL in women, age >70 years, serum creatinine >130 μmol/L [~1.47 mg/dL], and diabetes mellitus), evaluated as a continuous variable and across categories (0, 1, 2, and ≥3 points)

C

Comparator

AHEAD score of 0 (reference category for categorical comparisons), or comparison between patients with postoperative ICU stay ≤3 days (n=375) versus >3 days (n=143)

O

Outcome

Prolonged postoperative intensive care unit (ICU) stay, defined as an ICU stay longer than 72 hours (>3 days)

Main Result

Odds Ratio: 1.62 (95% CI 1.317–1.993)

p-value: p=<0.001

Limitations

Retrospective study design with potential for residual confounding
Cohort limited to two institutions in Turkey, which may limit generalizability
Potential variation in ICU discharge practices between participating institutions
Lack of post-discharge follow-up data beyond the immediate postoperative period
Unavailable established surgical risk scores (such as EuroSCORE II and ACEF) prevented adjustment or direct comparison of predictive performance
Retrospective nature may have resulted in residual confounding despite multivariable adjustment
Cohort was drawn from only two institutions, limiting generalizability to other healthcare environments
ICU discharge practices may vary between institutions and could influence ICU length of stay
Information regarding subsequent clinical events was unavailable, precluding assessment of outcomes beyond the immediate postoperative period
Established surgical risk scores (such as EuroSCORE II and ACEF) were not available in the dataset for adjustment or comparison

Implication

The simple, five-variable preoperative AHEAD score is independently associated with a progressively increased likelihood of prolonged ICU stay (>72 hours) following isolated CABG.

Abstract

Objective: Patients requiring longer postoperative intensive care unit (ICU) stay after coronary artery bypass grafting (CABG) are more likely to experience unfavorable clinical outcomes and increased healthcare resource utilization.The AHEAD score has been reported to predict adverse outcomes in several cardiovascular conditions.The present study sought to evaluate whether the AHEAD score could predict prolonged ICU stay in patients undergoing isolated CABG. Methods:We analyzed data from 518 consecutive patients undergoing isolated CABG at two tertiary referral centers between January 2020 and September 2025.A postoperative ICU stay longer than 72 hours was considered prolonged.The AHEAD score, consisting of atrial fibrillation, low hemoglobin level, elderly age, abnormal renal function, and diabetes mellitus, was evaluated both as a continuous variable and according to predefined score categories (0, 1, 2, and ≥3 points).Results: Of the 518 patients, 143 (27.6%) experienced prolonged ICU stay.These patients had significantly higher AHEAD scores than those without prolonged ICU stay [2 (1-3) vs. 1 (0-2), p<0.001].In multivariable analysis, increasing AHEAD score values were associated with a progressively ÖZ Amaç: Koroner arter bypass greftleme (KABG) sonrası uzamış yoğun bakım ünitesi (YBÜ) yatışı; olumsuz klinik sonuçlar ve artmış sağlık hizmeti maliyetleri ile ilişkilidir.AHEAD skorunun çeşitli kardiyovasküler hastalıklarda prognostik değeri gösterilmiştir.Bu çalışmada AHEAD skoru ile uzamış YBÜ yatışı arasındaki ilişkinin değerlendirilmesi amaçlandı.Yöntemler: Bu retrospektif iki merkezli çalışmaya Ocak 2020-Eylül 2025 tarihleri arasında izole KABG uygulanan 518 hasta dahil edildi.Uzamış YBÜ yatışı, 72 saatin üzerindeki yatış süresi olarak tanımlandı.Atriyal fibrilasyon, düşük hemoglobin düzeyi, ileri yaş, anormal böbrek fonksiyonu ve diyabetes mellitus bileşenlerinden oluşan AHEAD skoru hem sürekli değişken olarak hem de önceden tanımlanmış skor kategorilerine (0, 1, 2 ve ≥3 puan) göre analiz edildi.Bulgular: Toplam 518 hastanın 143'ünde (%27,6) uzamış YBÜ yatışı saptandı.Uzamış YBÜ yatışı olan hastalarda AHEAD skoru anlamlı olarak daha yüksekti [2 (1-3) vs. 1 (0-2), p<0,001].Çok değişkenli analizde AHEAD skorundaki her 1 puanlık artış, uzamış YBÜ yatışı ile bağımsız olarak ilişkili bulundu [olasılık oranı (OO): 1,620; %95 güven aralığı (GA): 1,317-1,993; p<0,001].

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Cite This Study

Şengör et al. (2026) conducted a cohort in Isolated coronary artery bypass grafting (CABG) (n=518). Preoperative AHEAD score (per 1-point increase) vs. Lower AHEAD score (or score of 0 in categorical analysis) was evaluated on Prolonged postoperative intensive care unit (ICU) stay (>72 hours) (OR 1.620, 95% CI 1.317-1.993, p=<0.001). Each 1-point increase in the preoperative AHEAD score independently predicted a higher risk of prolonged ICU stay (>72 hours) following isolated CABG (adjusted OR 1.620, 95% CI 1.317-1.993, p<0.001).

synapsesocial.com/papers/6ae2e1ad61f440a81e656a58 https://doi.org/10.14235/bas.galenos.2026.76743

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AHEAD Score and Prolonged Intensive Care Unit Stay Following Isolated Coronary Artery Bypass Grafting

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

AHEAD Score and Prolonged Intensive Care Unit Stay Following Isolated Coronary Artery Bypass Grafting

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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