title: Outcome of patients after cardiac surgery transferred to other hospitals following prolonged intensive care stay.
abstract: BACKGROUND
  The steady rise in complex cardiac procedures as well as the increase in comorbidity often result in a prolonged intensive care unit (ICU) stay. As a consequence, considerable numbers of patients have to be transferred to other hospitals so that the primary institution can maintain its capacity. The purpose of this study was to investigate the outcome of these patients.
  
  
  METHODS
  1,175 consecutive patients underwent various open heart procedures. 115 patients (9.8 %) requiring prolonged ICU treatment were retrospectively analyzed. 74 patients (EuroSCORE 8.1) underwent transferral to either rehabilitation units with ventilation capacity, multidisciplinary ICUs, or cardiac ICUs. 41 patients (EuroSCORE 7.9) remained in our hospital. Morbidity, mortality, and clinical condition were assessed and compared.
  
  
  RESULTS
  Transferred patients exhibited an overall mortality of 38 % compared to only 17 % in patients who remained. Mortality was 81 % in rehabilitation units, 30 % in multidisciplinary ICUs, and 16 % in cardiac ICUs. 66 % of the survivors among the transferred patients showed significantly impaired clinical condition (NYHA III-IV) compared to 33 % who showed a good postoperative condition (NYHA I-II). The patients who remained exhibited 44 % NYHA III-IV and 56 % NYHA I-II.
  
  
  CONCLUSIONS
  Transferral of patients after prolonged intensive care stay to external hospitals carries significant risks for early death and impaired outcome. However, transferral to cardiac ICUs appears to be an adequate option. Further studies may identify potential subgroups of patients who do not benefit from transferral.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University Hospital, Jena, Germany.
authors.forename: I M
authors.initials: IM
authors.lastname: Stöhr
authors.forename: J M
authors.initials: JM
authors.lastname: Albes
authors.forename: U
authors.initials: U
authors.lastname: Franke
authors.forename: J
authors.initials: J
authors.lastname: Wippermann
authors.forename: T U
authors.initials: TU
authors.lastname: Cohnert
authors.forename: E
authors.initials: E
authors.lastname: Hüttemann
authors.forename: T
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D012047:Rehabilitation Centers; D012121:Respiration, Artificial / Q000379:methods; D012720:Severity of Illness Index