Objective

Prolonged intensive care unit (ITU) stay has resource implications and impacts on morbidity and mortality. It is a marker of adverse outcome. We examine the impact of preoperative organ(s) reserve on prolonged ITU stay following cardiac surgery. Literature on the impact of preoperative organ(s) optimisation on outcome is limited.

Methods

Retrospective data analysis on 1592 consecutive patients admitted to ITU following cardiac surgery from January 2011 to October 2014 and discharged alive. Univariate analysis of dichotomous, categorical and continuous variables were performed to determine differences between patients who spent <2days Vs> 2days on ITU postop, using Chi-square or Fishers exact test. Multivariate regressions were made with all independent categorical and continuous variables that appeared significant for prolonged ITU stay.

Results

1592 patients, of whom 1137(71.4%) males, median age 69 and interquartile range 60-76 yrs. 566 patients had ITU stay> 2days. Prolonged ITU stay was associated with poor FEV1< 60% predicted (2.17:2.44, P=0.001,OR=0.76), high Creatinine (85: 105, P=0.001,OR=1.01),NYHA 3-4 (184 (18%):194 (34%), P=0.0029, OR=1.50),I mpaired LVEF <50% (120 (12%):123 (22%) P=0.0001,OR 2.21,IAPB (7(0.68%): 19 (3.36%,p=0.006), Diabetes (240(23%):116( 29%), P=0.010), age>70 yrs (67:72,P=0.007,OR=1.02), PSP>60mm Hg (16(1.6%32(32(5.6%), P=0.005.

Conclusion

Sub-optimal preoperative organ(s) reserves is associated with prolonged ITU stay following cardiac surgery. Efforts towards preoperative optimisation of organ(s) reserve may shorten ITU stay and improve overall outcome. Further research is needed on the impact of perioperative optimisation of organ reserve on resource implications and overall outcome of cardiac surgery.