title: Long-Term Outcome and Predictors of Noninstitutionalized Survival Subsequent to Prolonged Intensive Care Unit Stay After Cardiac Surgical Procedures.
abstract: BACKGROUND
  There are minimal data on long-term functional survival (alive and not institutionalized) in patients undergoing cardiac operations who require a prolonged intensive care unit length of stay (prICULOS). We sought to describe 1- and 5-year functional survival in patients who had a prICULOS (ICULOS ≥ 5 days) and determine predictors of functional survival at 1 year.
  
  
  METHODS
  Data were obtained from linked clinical and administrative databases from January 1, 2000 to December 31, 2011 to conduct this retrospective single-region analysis. Logistic regression was used to develop a model predicting functional survival at 1 year for patients who had a prICULOS after cardiac operations.
  
  
  RESULTS
  There were 9,545 admissions to the ICU after cardiac operations; of these patients, 728 (7.6%) experienced a prICULOS. There was an increasing trend in patients who had a prICULOS over this study period. The functional survival at 1 and 5 years from the surgical procedure for the non-prICULOS versus the prICULOS cohort was 1 year (94.9% versus 73.9%) and 5 years (84.9% versus 53.8%) (p < 0.001). Factors associated with lower rates of functional survival at 1 year were age 80 years or older, female sex, peripheral vascular disease, preoperative renal dysfunction, cerebrovascular disease, preoperative infection, need for extracorporeal membrane oxygenation/ventricular assist device (ECMO/VAD) after cardiotomy, number of days on mechanical ventilation, and number of days in the ICU beyond 5 days (area under the receiver operating characteristic [ROC] curve = 0.766).
  
  
  CONCLUSIONS
  The majority of patients who had a prICULOS experienced successful functional survival up to 5 years after cardiac operations. Identification of risk factors for poor functional survival may be of assistance to clinicians, patients, and families for prognostication and decision making.
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada. Electronic address: rmanji@sbgh.mb.ca.
authors.forename: Rizwan A
authors.initials: RA
authors.lastname: Manji
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Singal
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Moon
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Darren H
authors.initials: DH
authors.lastname: Freed
authors.affiliation: Department of Surgery, University of Manitoba and Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Menkis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors