title: Readmission to the intensive care unit in times of minimally invasive cardiac surgery: does size matter?
abstract: OBJECTIVE
  It is well known that patients who undergo readmission to an intensive care unit (ICU) after cardiac surgery face an increased risk of morbidity and mortality. The present study sought to evaluate whether less invasive procedures might be associated with a reduction of this economically as well as individually important problem. The role of the quantity of ICU and intermediate care (IMC) beds was investigated as well.
  
  
  METHODS
  Altogether, we reviewed 5,333 patients who underwent cardiac surgery in our department between 2005 and 2010. The incidence of and reasons for readmission were determined with regard to individual subgroups, particularly comparing minimally invasive procedures with conventional strategies.
  
  
  RESULTS
  A total of 5,132 patients were primarily discharged from the ICU. Out of this group, 293 patients were readmitted to the ICU at least once. After readmission, the average length of stay in the hospital was 21.9 ± 11.3 days compared to 12.8 ± 5.0 days in all other patients. Comparing the readmission rate in separate years, it was evident that this rate decreased with a growing ICU and IMC capacity. In patients who underwent less invasive cardiac surgery (ie, minimally invasive cardiac surgery, off-pump coronary artery bypass grafting), the readmission rates were significantly lower than in the entirety of patients studied.
  
  
  CONCLUSIONS
  Readmission to the ICU after cardiac surgery is associated with impaired outcome. Extended resources in terms of ICU and IMC capacity may positively influence this problem by decreasing the number of readmissions. Modern surgical strategies with less invasive procedures may be associated with a reduced incidence of readmission as well.
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Boeken
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany.
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Minol
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Assmann
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Mehdiani
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany.
authors.forename: Payam
authors.initials: P
authors.lastname: Akhyari
authors.affiliation: Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany.
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome