title: Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery--development of an entirely preoperative scorecard.
abstract: We sought to develop a predictive model based exclusively on preoperative factors to identify patients at risk for PrlICULOS following coronary artery bypass grafting (CABG). Retrospective analysis was performed on patients undergoing isolated CABG at a single center between June 1998 and December 2002. PrlICULOS was defined as initial admission to ICU exceeding 72 h. A parsimonious risk-predictive model was constructed on the basis of preoperative factors, with subsequent internal validation. Of 3483 patients undergoing isolated CABG between June 1998 and December 2002, 411 (11.8%) experienced PrlICULOS. Overall in-hospital mortality was higher among these patients (14.4% vs. 1.2%, P<or=0.0001). The following variables were found to be independent predictors of PrlICULOS: increased age, recent myocardial infarction, preoperative renal failure, cerebral and/or peripheral vascular disease, chronic obstructive pulmonary disease, ejection fraction <40%, previous CABG, triple-vessel and/or left main disease, NYHA class IV symptoms and urgent or emergent status. Subsequent validation of this model demonstrated a c-statistic of 78%. An internally-validated, risk predictive model of PrlICULOS in patients undergoing CABG was constructed. Based on preoperative clinical factors, a scorecard was developed allowing identification of these patients prior to surgery and allowing for strategies aimed at optimizing hospital resources.
authors.affiliation: Division of Cardiac Surgery, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Rm. 2629, Halifax, Nova Scotia, B3H 3A7, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Herman
authors.forename: Wojtek
authors.initials: W
authors.lastname: Karolak
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Yip
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Buth
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Légaré
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome