Readmission to the intensive care unit after fast-track cardiac surgery: an analysis of risk factors and outcome according to the type of operation.
BACKGROUND
In the present study, we investigated risk factors for intensive care unit (ICU) readmission after fasttrack cardiac surgery and analyzed outcome data according to the type of surgical procedure.


METHODS
Between 1999 and 2008, we prospectively enrolled 4270 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) (CABG group, n = 3754), isolated valve surgery (valve group, n = 353), or combined CABG and valve surgery (CABG + valve group, n = 163) in the study.


RESULTS
Ninety-eight patients (2.2%) were readmitted to the ICU. Of these patients, 73 were in the CABG group (1.9% of this group), 16 were in the valve group (4.5%), and 9 were in the CABG + valve group (5.5%). The main reason for ICU readmission in all groups was respiratory distress. A multivariate analysis showed that the independent risk factors for ICU readmission in the CABG group were an age >65 years (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5-5.4; P = .001), peripheral arterial disease (OR, 2.7; 95% CI, 1.2-6.1; P = .016), and drainage >500 mL (OR, 2.5; 95% CI, 1.2-5.1; P = .009). The independent risk factors for the valve group included only preoperative congestive heart failure (OR, 3.9; 95% CI, 1.3-11.7; P = .01). No independent risk factor was defined for the CABG + valve group. Mortality was significantly higher among the readmitted patients in all groups.


CONCLUSIONS
The risk factors for readmission after cardiac surgery with fast-track recovery may differ according to the type of operation. A strict control of volume balance and blood transfusion may further help prevent the occurrence of the most frequent cause of readmission, respiratory failure.
Toraman
Fevzi
F
Department of Anesthesiology and Reanimation, School of Medicine, Acibadem University, Istanbul, Turkey.
Senay
Sahin
S
Gullu
Umit
U
Karabulut
Hasan
H
Alhan
Cem
C
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D006333:Heart Failure / Q000150:complications; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D058729:Peripheral Arterial Disease / Q000150:complications; D011182:Postoperative Care; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors