title: Prolonged intensive care unit stay after coronary artery bypass graft surgery: Role of perioperative factors.
abstract: BACKGROUND
  Long stay in the Intensive Care Unit (ICU) after coronary artery bypass graft (CABG) surgery has been found to result in increased hospital mortality, poor long-term prognosis, prolonged hospital stay, and consequently, high cost and expenses. We, therefore, reviewed CABG surgery performed at the Madras Medical Mission Chennai, India, during a 3-month period to determine perioperative factors that are significant predictors of prolonged ICU admission.
  
  
  METHODS
  We retrospectively studied patients who had elective CABG surgery from November 2008 to January 2009. Information about the following perioperative variables were retrieved; patient demographics, history of co-morbid disease, pre-operative left ventricular (LV) function, the number of coronary vessels grafted, duration of bypass, the level of cardiovascular support post-bypass, the need for surgical re-exploration and duration of stay in the ICU. Prolonged ICU admission was defined as stay over 4 days after elective CABG surgery.
  
  
  RESULTS
  A total of 194 patients were reviewed, with males accounting for 84%, age ranged from 32 to 80 years, and duration of stay in the ICU from 2 to 14 days, with mean values of 58.06 ± 8.48 years and 3.96 ± 1.60 days, respectively. Univariate analysis showed significant differences in the number of patients with pulmonary hypertension (P = 0.002), mean bypass time (P = 0.018), requirement for LV support with inotrope (P = 0.021) and surgical re-exploration (P = 0.016) when patients with ICU stay ≤4 days were compared to those with stay over 4 days. Multiple regression revealed only LV support (β =0.69; P = 0.003) as the independent predictor of prolonged ICU stay.
  
  
  CONCLUSIONS
  This review showed LV support with inotrope as the only independent predictor of prolonged ICU stay after CABG surgery. Therefore, an excellent perioperative care leading to a reduced requirement for LV support after cardiopulmonary bypass for CABG surgery should be the goal.
authors.affiliation: From the Department of Anaesthesia, University College Hospital; Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Babatunde Babasola
authors.initials: BB
authors.lastname: Osinaike
authors.forename: Babatunde
authors.initials: B
authors.lastname: Okikiolu
authors.forename: Oluyemisi
authors.initials: O
authors.lastname: Olusesin