title: Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations.
abstract: BACKGROUND
  The aim of this study was to examine the impact of prolonged intensive care unit (ICU) stay on in-hospital mortality and long-term survival.
  
  
  METHODS
  Prospectively collected data from 6,101 consecutive patients who underwent surgery between 2003 and 2007 were analyzed. Prolonged ICU stay was defined as a total duration of ICU stay of 3 days or more postoperatively, including readmissions; patients with an ICU stay less than 3 days were identified as controls. Univariate and multiple variable analyses were performed to identify risk factors associated with prolonged ICU stay.
  
  
  RESULTS
  Of 6,101 patients, 1,139 (18.7%) patients had a prolonged ICU stay. These patients had a higher ICU mortality (10%) compared with controls (0.6%; p < 0.001). On discharge from the ICU, their hospital mortality was still 6-fold higher (1.2%) compared with controls (0.2%; p < 0.001). Finally, the patients who had prolonged ICU stays had lower survival after discharge from the ICU-89.2% and 81.2% at 1 year and 3 years, respectively, compared with 97.8% and 93.6%, respectively, for controls (p < 0.001). Multiple variable analysis revealed prolonged ICU stay to be an independent predictor of prolonged hospital stay, higher hospital mortality, and poorer long-term survival (all p < 0.001).
  
  
  CONCLUSIONS
  Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, United Kingdom. drbmahesh@yahoo.co.uk
authors.forename: Balakrishnan
authors.initials: B
authors.lastname: Mahesh
authors.forename: Cliff K
authors.initials: CK
authors.lastname: Choong
authors.forename: Kimberley
authors.initials: K
authors.lastname: Goldsmith
authors.forename: Caroline
authors.initials: C
authors.lastname: Gerrard
authors.forename: Samer A M
authors.initials: SA
authors.lastname: Nashef
authors.forename: Alain
authors.initials: A
authors.lastname: Vuylsteke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies