Determinants of early discharge from the intensive care unit after cardiac operations.
BACKGROUND
The length of stay in the intensive care unit is one of the factors limiting operating room utilization in cardiac surgery. We investigated the impact of a goal-oriented program aimed at discharging the patients from the intensive care unit the morning after the operation within a comprehensive model including other explanatory variables.


METHODS
A multivariable predictive model for early discharge from the intensive care unit was established using a stepwise forward logistic regression. The analysis was retrospectively conducted on 9120 consecutive patients undergoing cardiac surgical procedures at our institution.


RESULTS
A total of 1874 patients were discharged early from the intensive care unit. Factors associated with early discharge were ejection fraction, lowest hematocrit on cardiopulmonary bypass, lowest temperature on cardiopulmonary bypass, and the presence of the goal-oriented strategy (odds ratio, 5.5; 95% confidence interval, 4.8 to 6.3). Factors associated with late discharge were age, preoperative serum creatinine value, unstable angina, congestive heart failure, redo operation, combined operation, and cardiopulmonary bypass duration. An extubation time of 4 hours after the arrival in the intensive care unit was associated with the peak rate of early discharge. Patients being early discharged according to the goal-oriented strategy did not demonstrate a different complication rate compared with patients treated with a standard strategy.


CONCLUSIONS
Early discharge from the intensive care unit depends on a combination of preoperative and intraoperative factors, but most of all on the presence of a goal-oriented strategy. A very early extubation is not required for an early discharge from the intensive care unit.
Ranucci
Marco
M
Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy. cardioanestesia@virgilio.it
Bellucci
Carmen
C
Conti
Daniela
D
Cazzaniga
Anna
A
Maugeri
Bruno
B
D000367:Age Factors; D000789:Angina, Unstable / Q000209:etiology; D001831:Body Temperature; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D006040:Goals; D006333:Heart Failure / Q000209:etiology; D006400:Hematocrit; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation; D008962:Models, Theoretical; D011183:Postoperative Complications; D012086:Reoperation; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome
D003404:Creatinine