What happens after discharge? An analysis of long-term survival in cardiac surgical patients requiring prolonged intensive care

J Card Surg. 2012 Jan;27(1):13-9. doi: 10.1111/j.1540-8191.2011.01341.x. Epub 2011 Dec 12.

Abstract

Background: Cardiac surgical patients with postoperative complications frequently require prolonged intensive care yet survive to hospital discharge.

Methods: From January 1, 2002 to December 31, 2007, 11,541 consecutive patients underwent cardiac operations at a single academic institution. Of these, 11,084 (95.9%) survived to hospital discharge and comprised the study sample. Patients were retrospectively categorized into four groups according to intensive care unit (ICU) length of stay (LOS): <3 days, three to seven days, 7 to 14 days, and >14 days. Survival at 12 months was determined using the Social Security Death Index. Kaplan-Meier (KM) survival curves and Cox proportional hazards regression modeling (hazard ratio, HR) were used to analyze group differences in survival.

Results: One-year survival among the four groups according to ICU LOS was: <3 days, 97.0% (8407/8666); three to seven days, 91.2% (1481/1625); 7 to 14 days, 87.9% (356/405); and >14 days, 68.3% (265/388) (p < 0.001). Using multivariable regression analysis, adjusted overall mortality was significantly greater in patients with ICU LOS of three to seven days (HR = 1.51), 7 to 14 days (HR = 1.40), and >14 days (HR = 1.90) compared to patients with ICU LOS <3 days. Mortality among patients who survived more than six months postsurgery was significantly greater in patients with ICU LOS of three to seven days (HR = 1.37), 7 to 14 days (HR = 1.34), and >14 days (HR = 1.63).

Conclusions: Although cardiac surgery patients with major postoperative complications frequently survive to hospital discharge, survival after discharge is significantly reduced in patients requiring prolonged ICU care. Reduced survival in patients with a high risk of complications and anticipated long ICU stays should be considered when discussing surgical versus nonsurgical options.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures*
  • Cardiac Valve Annuloplasty
  • Coronary Artery Bypass
  • Critical Care / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Kaplan-Meier Estimate
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Discharge
  • Postoperative Complications / mortality*
  • Postoperative Complications / therapy
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors