title: Readmission to the intensive care unit after cardiac surgery: a single-center experience with 7105 patients.
abstract: OBJECTIVE
  Identification of patients at high risk for readmission to the Intensive Care Unit (ICU) after cardiac surgery is paramount. We evaluated the clinical characteristics of readmitted patients and identified perioperative prognostic variables for ICU readmission.
  
  
  METHODS
  A total of 7105 patients who underwent cardiac surgery between 2007 and 2010 and discharged after a primary stay in the ICU were reviewed retrospectively. Of these, 7.8% (554) patients were readmitted. The reasons for readmission and postoperative course were analyzed. Perioperative risk factors for readmission were determined by multivariate regression analysis.
  
  
  RESULTS
  Mortality of patients after readmission was 13.6% compared with 0.2% without recidivism (P<0.0001). Mean length of stay in hospital of patients requiring readmission was 24.9 ± 19.1 days and significantly longer compared to all other patients 12.3±8.4 days (P<0.0001). The main reasons for readmission were respiratory failure (39.0%) and cardiovascular instability (26.2%). Complex cardiac surgery, aortic surgery and extended stay in the ICU were the most powerful variables to predict ICU readmission.
  
  
  CONCLUSIONS
  ICU readmission was related to complex surgery and associated with impaired outcome. Respiratory complications were the most common reasons for readmission. Predictive renal and pulmonary risk factors indicate the need of preoperative preconditioning and patient selection.
authors.affiliation: Department of Cardiac Surgery, Heart Center Dresden, University, Dresden, Germany. djoskowiak@web.de
authors.forename: D
authors.initials: D
authors.lastname: Joskowiak
authors.forename: M
authors.initials: M
authors.lastname: Wilbring
authors.forename: M
authors.initials: M
authors.lastname: Szlapka
authors.forename: C
authors.initials: C
authors.lastname: Georgi
authors.forename: U
authors.initials: U
authors.lastname: Kappert
authors.forename: K
authors.initials: K
authors.lastname: Matschke
authors.forename: S M
authors.initials: SM
authors.lastname: Tugtekin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors