title: Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair.
abstract: OBJECTIVE
  After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days in the Cardiac Intensive Care Unit (CICU) while some may stay longer. We undertook this study to investigate the factors associated with shorter vs. longer length of stay in the CICU to help manage resources effectively.
  
  
  METHODS
  Patients who underwent ToF repair at Aga Khan University, Pakistan, between July 2006 and December 2011 were studied in a case-control design. Clinical parameters were compared between short stay group (SSG) (≤2 days) and long stay group (LSG) (>2 days). Odds ratios were calculated, and regression was performed.
  
  
  RESULTS
  Ninety-eight patients (LSG 65, SSG 33) were included. Patients with lower preoperative saturation were 2.67 times more likely to be in the LSG group (P = .02). At 4 hours postoperatively, patients with a higher inotropic score (odds ratio [OR] = 3.03, confidence interval [CI] = 1.19-7.7, P = .02), higher central venous pressure (OR = 3.04, CI = 1.27-7.32, P = .013), and significant tachycardia at 4 hours (OR = 3.5, CI = 1.19-10.3. P = .02) were at risk for having a prolonged CICU stay. On multivariate analysis, significant postoperative tachycardia at 4 hours (z-score ≥3) was highly specific (sensitivity = 38.5%, specificity = 84.9%) for predicting the chances of being in the LSG. Other predictors included preop O(2) saturation ≤82.5% (sensitivity = 61.1%, specificity = 63.0%) and CVP ≥10 mm Hg at 4 hours (sensitivity = 55.4%, specificity = 71.9%).
  
  
  CONCLUSIONS
  Patients who end up staying longer in the CICU have features that are distinctive in the immediate postoperative period, and this can help clinicians in identifying patients who may need more support.
authors: Medical College, The Aga Khan University, Karachi, Pakistan.
authors: Kisha A
authors: KA
authors: Beg
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors: Anwarul
authors: A
authors: Haq
authors: Section of Cardiothoracic Surgery, The Aga Khan University, Karachi, Pakistan.
authors: Muneer
authors: M
authors: Amanullah
authors: Medical College, The Aga Khan University, Karachi, Pakistan.
authors: Sobia N
authors: SN
authors: Laique
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors: Saleem
authors: S
authors: Sadqani
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors: Nadeem
authors: N
authors: Aslam
authors: Cardiac Intensive Care Unit, The Aga Khan University, Karachi, Pakistan.
authors: Amina Wali
authors: AW
authors: Rehmat
authors: Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors: Babar S
authors: BS
authors: Hasan
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010154:Pakistan; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clinical Parameters; Postoperative; Prolonged CICU Stay; Tetralogy of Fallot