What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac surgery (n=1404). Intervention: High risk score (8-12) on predictive index vs. Low risk score (0-1) on predictive index. Primary outcome: Long ICU stay (>2 days) (p=<0.001).

April 1, 1995Survey of Anesthesiology78 citationsOpen Access

A Predictive Index for Length of Stay in the Intensive Care Unit Following Cardiac Surgery

Q: What are the key findings of this study?

A five-variable preoperative predictive index successfully stratified patients, with 69.4% of high-risk patients experiencing an ICU stay of more than 2 days compared to 11.5% of low-risk patients.

JTJack V. Tu CMC. David Mazer CLCarey Levinton

Key Result

A five-variable preoperative predictive index successfully stratified patients, with 69.4% of high-risk patients experiencing an ICU stay of more than 2 days compared to 11.5% of low-risk patients.

Study Design

Type

Cohort (n=1,404)

Multicenter

Structured PICO

Can a multivariate predictive index predict length of ICU stay and death in patients following cardiac surgery?

Population

1,404 patients undergoing cardiac surgery (713 in derivation set, 691 in validation set)

Intervention

Development and validation of a multivariate predictive index

Outcome

Long ICU stay (more than 2 days)

A multivariate predictive index can successfully stratify risk for prolonged ICU stay and death following cardiac surgery, aiding in resource planning.

Main Result

Absolute Event Rate: 69.4% vs 11.5%

p-value: p=<0.001

Limitations

Restricted to variables available preoperatively, excluding perioperative factors like complications that may influence ICU stay.
Single-center study, which may not account for variations in patient care practices between different surgeons or institutions.
Lack of data pertaining to the specific intensivists caring for the patients, which could potentially influence the duration of an ICU stay.

Abstract

OBJECTIVE: To develop a predictive index for length of stay in the intensive care unit (ICU) following cardiac surgery. DESIGN: Univariate and multivariate logistic regression analysis of a cohort of 1404 patients divided into a derivation set of 713 patients and a validation set of 691 patients. SETTING: St. Michael's Hospital, Toronto, a tertiary care cardiovascular centre. PATIENTS: A consecutive sample of all patients undergoing cardiac surgery between Jan. 1 and Dec. 31, 1990 (derivation set), and Jan. 1 and Dec. 31, 1991 (validation set). MAIN OUTCOME MEASURE: A long ICU stay (more than 2 days). Other outcomes analysed were ICU stays over 4, 7 and 10 days, and death. RESULTS: In the derivation set increasing age, female sex, left ventricular function, type of surgery, and urgency of surgery were found to be independent risk factors for a long ICU stay in a multivariate logistic regression analysis. A predictive index was created by assigning risk scores based on the odds ratios of the significant variables in the logistic regression analysis. The predictive index was found to predict lengths of ICU stay greater than 2, 4, 7 and 10 days, and patient death in the validation set. CONCLUSIONS: Length of ICU stay and death following cardiac surgery can be predicted with a multivariate predictive index. The index has potential application as a means of stratifying cardiac surgical risk as well as in optimizing ICU resource planning when resources are limited.

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