title: Readmission to the intensive care unit after "fast-track" cardiac surgery: risk factors and outcomes.
abstract: BACKGROUND
  The introduction of "fast-track" management into cardiac surgery has significantly shortened the intensive care unit (ICU) length of stay. Readmission to the ICU, traditionally used as a quality index, has not been investigated in these patients. The aim of this study was to assess the causes, risk factors, and outcomes associated with readmission to the ICU.
  
  
  METHODS
  All patients undergoing open-heart surgery in a tertiary care, university-affiliated center were included in this prospective observational study. Preoperative and intraoperative data as well as ICU outcome were noted in all patients.
  
  
  RESULTS
  Over the 27-month study period,1,613 patients were targeted for fast track management (discharge from ICU on the first postoperative day). The readmission rate was 3.29% (53 patients). Forty-three percent of readmissions occurred within 24 hours of discharge usually because of pulmonary problems (43%) or arrhythmias (13%). Readmission was associated with a prolonged ICU stay (105 +/- 180.0 versus 19.2 +/- 2.4 hours of initial ICU stay) and worse outcome: the only patients who died (6 of 53, 11.3%) were in this group. On multivariate analysis, a Bernstein-Parsonnet risk estimate more than 20 strongly predicted readmission (odds ratio, 3.08; 95% confidence interval, 1.43 to 6.69).
  
  
  CONCLUSIONS
  Among a homogeneous group of patients targeted for fast-track management after cardiac surgery, readmission although uncommon is associated with a longer second ICU stay and significant mortality. The recognition of specific risk factors may allow for appropriate modification of the postoperative course.
authors.affiliation: Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petah Tiqva, Israel. akogan@clalit.org.il
authors.forename: Alexander
authors.initials: A
authors.lastname: Kogan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.forename: Gideon
authors.initials: G
authors.lastname: Sahar
authors.forename: Boris
authors.initials: B
authors.lastname: Orlov
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Vidne
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome