title: What happens after discharge? An analysis of long-term survival in cardiac surgical patients requiring prolonged intensive care.
abstract: BACKGROUND
  Cardiac surgical patients with postoperative complications frequently require prolonged intensive care yet survive to hospital discharge.
  
  
  METHODS
  From January 1, 2002 to December 31, 2007, 11,541 consecutive patients underwent cardiac operations at a single academic institution. Of these, 11,084 (95.9%) survived to hospital discharge and comprised the study sample. Patients were retrospectively categorized into four groups according to intensive care unit (ICU) length of stay (LOS): <3 days, three to seven days, 7 to 14 days, and >14 days. Survival at 12 months was determined using the Social Security Death Index. Kaplan-Meier (KM) survival curves and Cox proportional hazards regression modeling (hazard ratio, HR) were used to analyze group differences in survival.
  
  
  RESULTS
  One-year survival among the four groups according to ICU LOS was: <3 days, 97.0% (8407/8666); three to seven days, 91.2% (1481/1625); 7 to 14 days, 87.9% (356/405); and >14 days, 68.3% (265/388) (p < 0.001). Using multivariable regression analysis, adjusted overall mortality was significantly greater in patients with ICU LOS of three to seven days (HR = 1.51), 7 to 14 days (HR = 1.40), and >14 days (HR = 1.90) compared to patients with ICU LOS <3 days. Mortality among patients who survived more than six months postsurgery was significantly greater in patients with ICU LOS of three to seven days (HR = 1.37), 7 to 14 days (HR = 1.34), and >14 days (HR = 1.63).
  
  
  CONCLUSIONS
  Although cardiac surgery patients with major postoperative complications frequently survive to hospital discharge, survival after discharge is significantly reduced in patients requiring prolonged ICU care. Reduced survival in patients with a high risk of complications and anticipated long ICU stays should be considered when discussing surgical versus nonsurgical options.
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: K Miriam
authors.initials: KM
authors.lastname: Elfstrom
authors.forename: Dustin
authors.initials: D
authors.lastname: Hatefi
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Kilgo
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D058385:Cardiac Valve Annuloplasty; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors