Readmission to the intensive care unit after "fast-track" cardiac surgery: risk factors and outcomes

Ann Thorac Surg. 2003 Aug;76(2):503-7. doi: 10.1016/s0003-4975(03)00510-1.


Background: The introduction of "fast-track" management into cardiac surgery has significantly shortened the intensive care unit (ICU) length of stay. Readmission to the ICU, traditionally used as a quality index, has not been investigated in these patients. The aim of this study was to assess the causes, risk factors, and outcomes associated with readmission to the ICU.

Methods: All patients undergoing open-heart surgery in a tertiary care, university-affiliated center were included in this prospective observational study. Preoperative and intraoperative data as well as ICU outcome were noted in all patients.

Results: Over the 27-month study period,1,613 patients were targeted for fast track management (discharge from ICU on the first postoperative day). The readmission rate was 3.29% (53 patients). Forty-three percent of readmissions occurred within 24 hours of discharge usually because of pulmonary problems (43%) or arrhythmias (13%). Readmission was associated with a prolonged ICU stay (105 +/- 180.0 versus 19.2 +/- 2.4 hours of initial ICU stay) and worse outcome: the only patients who died (6 of 53, 11.3%) were in this group. On multivariate analysis, a Bernstein-Parsonnet risk estimate more than 20 strongly predicted readmission (odds ratio, 3.08; 95% confidence interval, 1.43 to 6.69).

Conclusions: Among a homogeneous group of patients targeted for fast-track management after cardiac surgery, readmission although uncommon is associated with a longer second ICU stay and significant mortality. The recognition of specific risk factors may allow for appropriate modification of the postoperative course.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / methods*
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Heart Diseases / surgery
  • Humans
  • Incidence
  • Intensive Care Units*
  • Length of Stay*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / epidemiology*
  • Probability
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Sex Distribution
  • Survival Rate
  • Treatment Outcome