title: Prolonged intensive care unit stay of patients after cardiac surgery: initial clinical results and follow-up.
abstract: BACKGROUND
  Prolonged intensive care unit (ICU) stay in cardiac surgery patients often results in a poorer clinical course and decreased survival postdischarge. Data on clinical outcomes and prognosis are limited. We aimed to identify perioperative factors that would predict prolonged ICU stay and to evaluate their impact on clinical outcomes.
  
  
  METHODS
  Demographic and clinical data on the perioperative course and outcome of 7,646 consecutive patients who underwent cardiac surgery at our institution were retrospectively analyzed over a 4-year period. Duration of ICU stay was defined as: less than 3 days (Group 1, n = 6,574), greater than 3 days (Group 2, n = 466), and more than 7 days (Group 3, n = 606).
  
  
  RESULTS
  The in-hospital mortality rate was significantly elevated in patients with a prolonged ICU stay (Group III, 16.1%; Group II, 8.4%; and Group I, 2.5%; p < 0.05). Prolonged ICU stay was associated with a complicated clinical course and a significantly higher incidence of respiratory and renal insufficiency. Multivariate analysis confirmed neurological, renal, and respiratory complications to be the predictive of prolonged ICU stay. Two-year survival also correlated with duration of ICU stay (Group I, 85.9%; Group II, 64.2%; and Group III, 57.4%; p < 0.0001).
  
  
  CONCLUSIONS
  Prolonged ICU stay is associated with a complicated clinical course and decreased overall survival. Treatment for patients with respiratory impairment should be aggressively optimized.
authors.affiliation: Department of Cardiac Surgery, Heart Center Dresden Ltd. University Hospital, Dresden, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Joskowiak
authors.forename: Utz
authors.initials: U
authors.lastname: Kappert
authors.forename: Klaus
authors.initials: K
authors.lastname: Matschke
authors.forename: Sems
authors.initials: S
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; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000209:etiology / Q000628:therapy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000209:etiology / Q000628:therapy; D016017:Odds Ratio; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome