Factors Influencing a Prolonged ICU Stay After Coronary Artery Bypass Graft Surgery: A Cross-sectional Study

Document Type: Original Article

Authors

1 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Department of Nursing, Arak University of Medical Sciences, Arak, IR Iran.

3 Echocardiography Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: A prolonged hospital stay causes bed occupancy rates and increases hospital costs. This study aimed to determine the factors affecting the ICU length of stay after coronary artery bypass graft surgery (CABG).
Methods: In this descriptive cross-sectional study, 346 patients undergoing CABG between March 2015 and September 2016 were selected through convenience sampling. Based on their ICU length of stay, the patients were divided into 2 groups: ICU length of stay ≤ 72 hours (3 d) (Group A) and ICU length of stay > 72 hours (Group B).
Results: Among the 346 patients studied, 93 (27%) patients had an ICU length of stay ≥ 72 hours and 253 (73%) patients had an ICU length of stay < 72 hours. There was no statistically significant difference in the ICU length of stay between the women and men (P = 0.536). The subjects with a history of diabetes and hypertension were more likely to stay in the ICU for a longer period. For the patients with an ICU stay > 72 hours, the number of blood products received; the use of inotropes; the duration of cardiopulmonary bypass; the duration of intubation; cardiac, pulmonary, neural, and renal complications; infection, receiving inotropes in the ICU; postoperative bleeding; return to the operating room; receiving blood; and a history of bleeding were among the influential factors during the patients’ stay in the ICU.
Conclusions: The results of this study showed that the factors increasing the ICU length of stay after CABG were old age, a reduced left ventricular ejection fraction, a prolonged cardiopulmonary bypass time, receiving inotropes, prolonged intubation, the use of the intra-aortic balloon pump, receiving blood products, and postoperative bleeding.

Keywords


1. Imanipour M, Bassampour S, Bahrani N.
Preoperative variables associated with
extubation time in patients undergoing coronary
artery bypass graft surgery. Hayat. 2006; 12 (1)
:5-16
URL: http://hayat.tums.ac.ir/article-1-214-
fa.htm.
2. Khairudin Z. Determinants of prolonged stay
after coronary artery bypass graft surgery.
Procedia-Social and Behavioral Sciences. 2012
Jan 1;36:87-95.
3. Michalopoulos A, Tzelepis G, Pavlides G,
Kriaras J, Dafni U, Geroulanos S. Determinants
of duration of ICU stay after coronary artery
bypass graft surgery. British journal of
anaesthesia. 1996 Aug 1;77(2):208-12.
4. Almashrafi A, Elmontsri M, Aylin P. Systematic
review of factors influencing length of stay in ICU after adult cardiac surgery. BMC health
services research. 2016 Dec;16(1):318.
5. Weissman C. Pulmonary complications after
cardiac surgery. InSeminars in cardiothoracic
and vascular anesthesia 2004 Sep (Vol. 8, No. 3,
pp. 185-211). 708 Glen Cove Avenue, Glen
Head, NY 11545, USA: Westminster
Publications, Inc..
6. Somlo DR, Repenning NP, Mangi AA. InHospital Delays Result in Worse Patient
Outcomes and Higher Cost after Cardiac
Surgery. The Annals of thoracic surgery. 2018
Jun 13.
7. Richey M, Mann A, He J, Daon E, Wirtz K,
Dalton A, Flynn BC. Implementation of an early
extubation protocol in cardiac surgical patients
decreased ventilator time but not intensive care
unit or hospital length of stay. Journal of
cardiothoracic and vascular anesthesia. 2018
Apr 1;32(2):739-44.
8. Meadows K, Gibbens R, Gerrard C, Vuylsteke
A. Prediction of patient length of stay on the
intensive care unit following cardiac surgery: a
logistic regression analysis based on the cardiac
operative mortality risk calculator, EuroSCORE.
Journal of cardiothoracic and vascular
anesthesia. 2018 Mar 7.
9. Cigarroa CL, van den Bosch SJ, Tang X,
Gauvreau K, Baird CW, DiNardo JA, Kheir JN.
Measurement of Dead Space Fraction Upon ICU
Admission Predicts Length of Stay and Clinical
Outcomes Following Bidirectional
Cavopulmonary Anastomosis. Pediatric Critical
Care Medicine. 2018 Jan 1;19(1):23-31.
10. Toptas M, Sengul Samanci N, Akkoc İ, Yucetas
E, Cebeci E, Sen O, Can MM, Ozturk S. Factors
Affecting the Length of Stay in the Intensive
Care Unit: Our Clinical Experience. BioMed
research international. 2018;2018.
11. Azarfarin R, Ashouri N, Totonchi Z,
Bakhshandeh H, Yaghoubi A. Factors
influencing prolonged ICU stay after open heart
surgery. Research in cardiovascular medicine.
2014 Nov;3(4).
12. Golitaleb M, Kargar F, Aghai FG, Harorani M,
Jadidi A, Abkenar HB, Haghazali M.
Hyperbilirubinemia after open cardiac surgery.
Iranian Heart Journal. 2017 Jun 1;18(2):30-5.
13. Tunç M, Şahutoğlu C, Karaca N, Kocabaş S,
Aşkar FZ. Risk Factors for Prolonged Intensive
Care Unit Stay After Open Heart Surgery in
Adults. Turkish journal of anaesthesiology and
reanimation. 2018 Aug;46(4):283.
14. De Maria R, Mazzoni M, Parolini M, Gregori D,
Bortone F, Arena V, Parodi O. Predictive value
of EuroSCORE on long term outcome in cardiac
surgery patients: a single institution study.
Heart. 2005 Jun 1;91(6):779-84.
15. 15.Golitaleb M, Haghazali M, Golaghaie F,
Ghadrdoost B, Sahebi A, Kargar F. Changes in
Liver Enzymes in the Patients Undergoing Open
Cardiac Surgery and Related Factors.
International Journal of Advanced
Biotechnology and Research. 2017 Jan
1;8(3):2086-91.
16. Mahesh B, Choong CK, Goldsmith K, Gerrard
C, Nashef SA, Vuylsteke A. Prolonged stay in
intensive care unit is a powerful predictor of
adverse outcomes after cardiac operations. The
Annals of thoracic surgery. 2012 Jul
1;94(1):109-16.
17. Rohde SL, Baker RA, Tully PJ, Graham S,
Cullen H, Knight JL. Preoperative and
intraoperative factors associated with long-term
survival in octogenarian cardiac surgery
patients. The Annals of thoracic surgery. 2010
Jan 1;89(1):105-11.
18. Silberman S, Bitran D, Fink D, Tauber R, Merin
O. Very prolonged stay in the intensive care unit
after cardiac operations: early results and late
survival. The Annals of thoracic surgery. 2013
Jul 1;96(1):15-22.
19. Cserép Z, Losoncz E, Tóth R, Tóth A, Juhász B,
Balog P, Vargha P, Gál J, Contrada RJ, Falger
PR, Székely A. Self-rated health is associated
with the length of stay at the intensive care unit
and hospital following cardiac surgery. BMC
cardiovascular disorders. 2014 Dec;14(1):171.
20. Mirinazhad M, Parsa D, Faridaalaee G,
Bilehjani E, Irajian M, Shadvar K, Naghipour B.
Prevalence and Risk Factors for Prolonged ICU

Stay After Adult Cardiac Surgery. Annals of
Anesthesiology and Critical Care. 2016;1(1).
21. Flegler S, Paro FM. Factors associated with
intubation time and ICU stay after CABG.
Brazilian journal of cardiovascular surgery.
2015 Dec;30(6):631-5.
22. Ing RJ, Goldberg SP, Twite MD. Anesthetic
Techniques for Specific Cardiac Pathology.
InPediatric and Congenital Cardiology, Cardiac
Surgery and Intensive Care 2014 (pp. 625-657).
Springer, London.
23. Hein OV, Birnbaum J, Wernecke K, England M,
Konertz W, Spies C. Prolonged intensive care
unit stay in cardiac surgery: risk factors and
long-term-survival. The Annals of thoracic
surgery. 2006 Mar 1;81(3):880-5.
24. Michalopoulos A, Nikolaides A, Antzaka C,
Deliyanni M, Smirli A, Geroulanos S,
Papadimitriou L. Change in anaesthesia practice
and postoperative sedation shortens ICU and
hospital length of stay following coronary artery
bypass surgery. Respiratory medicine. 1998 Aug
1;92(8):1066-70.