title: Prognosis of Prolonged Intensive Care Unit Stay After Aortic Valve Replacement for Severe Aortic Stenosis in Octogenarians.
abstract: OBJECTIVE
  Octogenarians considered for cardiac surgery encounter more complications than other patients. Postoperative complications raise the question of continuation of high-cost care for patients with limited life expectancy. Duration of hospitalization in intensive care after cardiac surgery may differ between octogenarians and other patients. The objectives were evaluating the mortality rate of octogenarians experiencing prolonged hospitalization in intensive care and defining the best cut-off for prolonged intensive care unit length of stay.
  
  
  METHODS
  A single-center observational study.
  
  
  METHODS
  A postoperative surgical intensive care unit in a tertiary teaching hospital in Paris, France.
  
  
  METHODS
  All consecutive patients older than 80 years considered for aortic valve replacement for aortic stenosis were included.
  
  
  RESULTS
  Mortality rate was determined among patients experiencing prolonged stay in intensive care with organ failure and without organ failure. An ROC curve determined the optimal cut-off defining prolonged hospitalization in intensive care according to the occurrence of postoperative complications. Multivariate analysis determined risk factors for early death or prolonged intensive care stay. The optimal cut-off defining prolonged intensive care unit length of stay was 4 days. Low ventricular ejection fraction (odds ratio [OR] = 0.95; 95% confidence interval [CI] 0.96-0.83; p = 0.0016), coronary disease (OR = 2.34; 95% CI 1.19-4.85; p = 0.014), and need for catecholamine (OR = 2.79; 95% CI 1.33-5.88; p = 0.0068) were associated with eventful postoperative course. There was not a hospitalization duration beyond which the prognosis significantly worsened.
  
  
  CONCLUSIONS
  Prolonged length of stay in ICU without organ failure is not associated with increased mortality. No specific duration of hospitalization in intensive care was associated with increased mortality. Continuation of care should be discussed on an individual basis.
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France. Electronic address: pascalaugustin@hotmail.com.
authors.forename: Pascal
authors.initials: P
authors.lastname: Augustin
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: †Département d'Anesthésie Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris 5, René Descartes, Paris, France.
authors.forename: Vibol
authors.initials: V
authors.lastname: Chhor
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Provenchère
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Darko
authors.initials: D
authors.lastname: Arnaudovski
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Hassan
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dilly
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Allou
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
authors.affiliation: Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France; ‡Service d'Anesthésie, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Philip
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: cardiac surgery; intensive care; octogenarians; prolonged hospitalization