title: Clinical outcomes in patients with prolonged intensive care unit length of stay after cardiac surgical procedures.
abstract: BACKGROUND
  Advances in critical care medicine have allowed for improved care of patients requiring prolonged intensive care unit length of stay (prICULOS) after cardiac operations, yet little is known regarding their eventual outcomes. The purpose of this study was to examine short- and long-term outcomes in patients undergoing cardiac operations with prICULOS.
  
  
  METHODS
  All cases of coronary artery bypass grafting (CABG), aortic valve, mitral valve, and combined CABG/valve surgical procedures performed at a single institution from July 2002 to July 2007 were identified. All-cause mortality in patients discharged alive from the hospital was determined until December 2007 through linkage with the Social Security Death Index. Patients who experienced intraoperative death or those with missing or invalid social security numbers were excluded. The definition of prICULOS was total ICULOS greater than 7 days.
  
  
  RESULTS
  A total of 3,478 patients met inclusion criteria. One hundred thirty-seven of three thousand four hundred seventy-eight patients (3.9%) experienced prICULOS. These patients were more likely to be older than 70 years (55.5% versus 30.5%; p<0.0001) and to have had recent myocardial infarction (28.5% versus 20.1%; p=0.02), previous cardiac operation (18.3% versus 6.9%; p<0.0001), and emergent status (9.5% versus 1.6%; p<0.0001). They experienced greater in-hospital mortality (37.2% versus 1.7%; p<0.0001) and those who were discharged alive had worse long-term survival (log-rank, p<0.0001). After risk adjustment, prICULOS emerged as a significant predictor of in-hospital death (odds ratio [OR] 20.9; 95% confidence interval [CI], 12.9-33.7) and decreased long-term survival (hazard ratio [HR] 2.9; 95% CI, 2.0-4.3).
  
  
  CONCLUSIONS
  Patients with prICULOS after cardiac operations have worse overall outcomes. These data may be used to inform these patients and their families of realistic expectations regarding their clinical course.
authors.affiliation: Department of Cardiac Surgery, Saint John Regional Hospital, New Brunswick, Canada.
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.forename: Curtis
authors.initials: C
authors.lastname: Anderson
authors.forename: Alan
authors.initials: A
authors.lastname: Kypson
authors.forename: Linda
authors.initials: L
authors.lastname: Kindell
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002423:Cause of Death; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; 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; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome