Day 0 intensive care unit discharge - risk or benefit for the patient who undergoes myocardial revascularization?
OBJECTIVE
Day 0 intensive care unit (ICU) discharge allows to use one ICU bed for two patients. Results of this policy were analysed.


METHODS
From January 1998 to June 2001, 1194 patients who had myocardial revascularization in the morning were discharged on the same day (Group 0, n=647), or one (Group 1, n=521) or many days (Group 2, n=26) after surgery. Criteria for day 0 discharge were: early extubation with at least 2h of observation, stable hemodynamic status, no significant bleeding, no arrhythmias, normal EKG and normal neurological evolution.


RESULTS
Mean ICU stay was 4.0+/-1.2h in Group 0, 17.5+/-4.0 h in Group 1 and 65.8+/-46.6h in Group 2 (P(1), among Groups, <0.001; P(2), between Groups 0 and 1, <0.001). In 613 cases (94.7% of patients in Group 0) the same ICU bed was used for another patient. Postoperative in-hospital stay was 4.1+/-2.3 d in Group 0, 4.9+/-3.1 d in Group 1 and 7.4+/-6.8 in Group 2 (P(1)<0.001; P(2)<0.001). Fifteen patients (1.2%) were readmitted to the ICU, seven in Group 0 (1.1%), five in Group 1 (1.0%) and three (11.5%) in Group 2 (P(1)<0.001, P(2) n.s.), because of bleeding (five cases in Group 0, two in Group 1, none in Group 2; P(1)<0.001, P(2)), cerebrovascular accident (two cases in Group 0, none in Group 1, three in Group 2; P(1)<0.001, P(2) n.s.), acute myocardial infarction (no case in Groups 0 and 2, two in Group 1; P(1) n.s., P(2) n.s.) and acute renal failure (no case in Group 0 and 2, one case in Group 1; P(1) n.s., P(2) n.s.). Nine patients (0.8%) died (three, 0.5%, in Group 0, three, 0.6%, in Group 1 and three, 11.5%, in Group 2; P(1)<0.001, P(2) n.s.), four (one in Group 0, two in Group 1 and one in Group 2, P(1) 0.006, P(2) n.s.) in the hospital (two from cardiac and two from non-cardiac causes) and five (two in Group 0, one in Group 1 and two in Group 2, P(1)<0.001, P(2) n.s.) outside the hospital within the 30th day of surgery (one from cardiac and four from non-cardiac causes). No patient in Group 0 died from cardiac causes.


CONCLUSIONS
Day 0 ICU discharge can be obtained in selected patients without an increased risk of death or of ICU readmission. The impact in terms of resource saving is striking.
Calafiore
Antonio Maria
AM
Department of Cardiology and Cardiac Surgery, G. D'Annunzio University, Chieti, Italy. calafiore@unich.it
Scipioni
Giovanni
G
Teodori
Giovanni
G
Di Giammarco
Gabriele
G
Di Mauro
Michele
M
Canosa
Carlo
C
Iacò
Angela Lorena
AL
Vitolla
Giuseppe
G
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009204:Myocardial Revascularization / Q000401:mortality; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors