Predictive Risk Factors for Prolonged Stay in the Intensive Care Unit after Surgery for Acute Aortic Dissection Type A_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHENGWei , CHIYi-fan , NIUZhao-zhuo , LinMing-shan , QIAOYou-jin , WUJian-tao ,  SUNLong

Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao 266071 Shandong, P. R. China;

Corresponding author：

SUNLong, Email: sunlongboshi@sina.com

Keywords：

Acute aortic dissection; Risk factors; Intensive care unit

DOI：

10.7507/1007-4848.20160103

Video：

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Objective To identify the predictors of prolonged stay in the intensive care unit (ICU) in patients undergoing surgery for acute aortic dissection type A. Methods We retrospectively analyzed the clinical data of 80 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from December 2009 through December 2013. The mean age of the patients was 48.9±12.5 years, including 54 males (67.5%) and 26 females (32.5%). The patients were divided into two groups based on their stay time in the ICU. Prolonged length of ICU stay was defined as 5 days or longer time in the ICU postoperatively. There were 67 patients with length of ICU stay shorter than 5 days, 13 patients with length of ICU stay 5 days or longer time. Univariate and multivariate analysis (logistic regression) were used to identify the predictive risk factors. Results The length of ICU stay was 63.2±17.4 hours and 206.9±25.4 hours separately. Overall in-hospital mortality was 3.0% and 15.4% respectively in the two groups. In univariate analyses, there were statistically significant differences with respect to the age, the European system for cardiac operative risk evaluation (EuroSCORE), the preoperative D-dimmer level, total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA), inotropes and occurrence of postoperative stroke, acute renal failure and acute respiratory failure, ICU stay duration and hospital stay duration between the patients with length of ICU stay shorter than 5 days and longer than 5 days. Multivariate logistic analysis showed that CPB time, occurrence of postoperative stroke, acute renal failure, or acute respiratory failure were independent predictors for prolonged ICU stay. Conclusion The incidence of prolonged ICU stay is high after surgery for acute aortic dissection type A. It can be predicted by CPB time, occurrence of postoperative stroke, acute renal failure, and acute respiratory failure were independent predictors for prolonged ICU stay. For patients with these risk factors, more perioperative care strategies are needed in order to shorten the ICU stay time.

Citation： SHENGWei, CHIYi-fan, NIUZhao-zhuo, LinMing-shan, QIAOYou-jin, WUJian-tao, SUNLong. Predictive Risk Factors for Prolonged Stay in the Intensive Care Unit after Surgery for Acute Aortic Dissection Type A. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 434-439. doi: 10.7507/1007-4848.20160103 Copy

1.	生伟, 池一凡, 侯文明, 等. 急性主动脉夹层动脉瘤术后低氧血症发生的危险因素分析. 中国胸心血管外科临床杂志, 2013, 20(3):298-303.
2.	Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg, 2002, 73(3):714-718.
3.	Bignami E, Frati E, Ceriotti F, et al. Urinary neutrophil gelatinase-associated lipocalin as an early predictor of prolonged intensive care unit stay after cardiac surgery. Ann Card Anaesth, 2012, 15(1):13-17.
4.	Hein OV, Birnbaum J, Wernecke K, et al. Prolonged intensive care unit stay in cardiac surgery:risk factors and long-term-survival. Ann Thorac Surg, 2006, 81(3):880-885.
5.	Ghotkar SV, Grayson AD, Fabri BM, et al. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting. J Cardiothorac Surg, 2006, 1:14.
6.	Giakoumidakis K, Baltopoulos GI, Charitos C, et al. Risk factors for prolonged stay in cardiac surgery intensive care units. Nurs Crit Care, 2011, 16(5):243-251.
7.	Bapat V, Allen D, Young C, et al. Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg, 2005, 20(3):212-217.
8.	Hellgren L, Ståhle E. Quality of life after heart valve surgery with prolonged intensive care. Ann Thorac Surg, 2005, 80(5):1693-1698.
9.	Legras A, Bruzzi M, Nakashima K, et al. Risk factors for hospital death after surgery for type A aortic dissection. Asian Cardiovasc Thorac Ann, 2012, 20(3):269-274.
10.	J Olsson C, Hillebrant CG, Liska J, et al. Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions. J Vasc Surg, 2013, 58(2):333-339.
11.	Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4):1246-1250.
12.	Macrina F, Puddu PE, Sciangula A, et al. Artificial neural networks versus multiple logistic regression to predict 30-day mortality after operations for type a ascending aortic dissection. Open Cardiovasc Med J, 2009, 3:81-95.
13.	Chavanon O, Costache V, Bach V, et al. Preoperative predictive factors for mortality in acute type A aortic dissection:an institutional report on 217 consecutives cases. Interact Cardiovasc Thorac Surg, 2007, 6(1):43-46.
14.	Eltheni R, Giakoumidakis K, Brokalaki H, et al. Predictors of prolonged stay in the intensive care unit following cardiac surgery. ISRN Nurs, 2012, 2012:691561.
15.	De Cocker J, Messaoudi N, Stockman BA, et al. Preoperative prediction of intensive care unit stay following cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1):60-67.
16.	Atoui R, Ma F, Langlois Y, et al. Risk factors for prolonged stay in the intensive care unit and on the ward after cardiac surgery. J Card Surg, 2008, 23(2):99-106.
17.	Messaoudi N, De Cocker J, Stockman B, et al. Prediction of prolonged length of stay in the intensive care unit after cardiac surgery:the need for a multi-institutional risk scoring system. J Card Surg, 2009, 24(2):127-133.
18.	Nissinen J, Biancari F, Wistbacka JO, et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion, 2009, 24(5):297-305.
19.	Taniguchi FP, Souza AR, Martins AS. Cardiopulmonary bypass time as a risk factor for acute renal failure. Rev Bras Cir Cardiovasc, 2007, 22(2):201-205.
20.	王柏春, 刘宗泓, 孟维鑫, 等. 不同体、脑灌注方式对Stanford A型主动脉夹层患者的脑保护研究. 中国胸心血管外科临床杂志, 2013, 20(5):529-532.
21.	Wiedemann D, Kocher A, Dorfmeister M, et al. Effect of cerebral protection strategy on outcome of patients with Stanford type A aortic dissection. J Thorac Cardiovasc Surg, 2013, 146(3):647-655.
22.	Greenberg SB, Murphy G, Alexander J, et al. Cerebral desaturation events in the intensive care unit following cardiac surgery. J Crit Care, 2013, 28(3):270-276.
23.	Joskowiak D, Kappert U, Matschke K, et al. Prolonged intensive care unit stay of patients after cardiac surgery:initial clinical results and follow-up. Thorac Cardiovasc Surg, 2013, 61(8):701-707.
24.	Tekumit H, Uzun K, Cenal AR, et al. Determinants of mortality in patients requiring prolonged intensive care unit stay after elective isolated on-pump coronary artery bypass grafting surgery. Kardiol Pol, 2010, 68(3):257-262.
25.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3):691-696.
26.	Hein OV, Birnbaum J, Wernecke KD, et al. Intensive care unit stay of more than 14 days after cardiac surgery is associated with non-cardiac organ failure. J Int Med Res, 2006, 34(6):695-703.

1. 生伟, 池一凡, 侯文明, 等. 急性主动脉夹层动脉瘤术后低氧血症发生的危险因素分析. 中国胸心血管外科临床杂志, 2013, 20(3):298-303.
2. Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg, 2002, 73(3):714-718.
3. Bignami E, Frati E, Ceriotti F, et al. Urinary neutrophil gelatinase-associated lipocalin as an early predictor of prolonged intensive care unit stay after cardiac surgery. Ann Card Anaesth, 2012, 15(1):13-17.
4. Hein OV, Birnbaum J, Wernecke K, et al. Prolonged intensive care unit stay in cardiac surgery:risk factors and long-term-survival. Ann Thorac Surg, 2006, 81(3):880-885.
5. Ghotkar SV, Grayson AD, Fabri BM, et al. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting. J Cardiothorac Surg, 2006, 1:14.
6. Giakoumidakis K, Baltopoulos GI, Charitos C, et al. Risk factors for prolonged stay in cardiac surgery intensive care units. Nurs Crit Care, 2011, 16(5):243-251.
7. Bapat V, Allen D, Young C, et al. Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg, 2005, 20(3):212-217.
8. Hellgren L, Ståhle E. Quality of life after heart valve surgery with prolonged intensive care. Ann Thorac Surg, 2005, 80(5):1693-1698.
9. Legras A, Bruzzi M, Nakashima K, et al. Risk factors for hospital death after surgery for type A aortic dissection. Asian Cardiovasc Thorac Ann, 2012, 20(3):269-274.
10. J Olsson C, Hillebrant CG, Liska J, et al. Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions. J Vasc Surg, 2013, 58(2):333-339.
11. Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4):1246-1250.
12. Macrina F, Puddu PE, Sciangula A, et al. Artificial neural networks versus multiple logistic regression to predict 30-day mortality after operations for type a ascending aortic dissection. Open Cardiovasc Med J, 2009, 3:81-95.
13. Chavanon O, Costache V, Bach V, et al. Preoperative predictive factors for mortality in acute type A aortic dissection:an institutional report on 217 consecutives cases. Interact Cardiovasc Thorac Surg, 2007, 6(1):43-46.
14. Eltheni R, Giakoumidakis K, Brokalaki H, et al. Predictors of prolonged stay in the intensive care unit following cardiac surgery. ISRN Nurs, 2012, 2012:691561.
15. De Cocker J, Messaoudi N, Stockman BA, et al. Preoperative prediction of intensive care unit stay following cardiac surgery. Eur J Cardiothorac Surg, 2011, 39(1):60-67.
16. Atoui R, Ma F, Langlois Y, et al. Risk factors for prolonged stay in the intensive care unit and on the ward after cardiac surgery. J Card Surg, 2008, 23(2):99-106.
17. Messaoudi N, De Cocker J, Stockman B, et al. Prediction of prolonged length of stay in the intensive care unit after cardiac surgery:the need for a multi-institutional risk scoring system. J Card Surg, 2009, 24(2):127-133.
18. Nissinen J, Biancari F, Wistbacka JO, et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion, 2009, 24(5):297-305.
19. Taniguchi FP, Souza AR, Martins AS. Cardiopulmonary bypass time as a risk factor for acute renal failure. Rev Bras Cir Cardiovasc, 2007, 22(2):201-205.
20. 王柏春, 刘宗泓, 孟维鑫, 等. 不同体、脑灌注方式对Stanford A型主动脉夹层患者的脑保护研究. 中国胸心血管外科临床杂志, 2013, 20(5):529-532.
21. Wiedemann D, Kocher A, Dorfmeister M, et al. Effect of cerebral protection strategy on outcome of patients with Stanford type A aortic dissection. J Thorac Cardiovasc Surg, 2013, 146(3):647-655.
22. Greenberg SB, Murphy G, Alexander J, et al. Cerebral desaturation events in the intensive care unit following cardiac surgery. J Crit Care, 2013, 28(3):270-276.
23. Joskowiak D, Kappert U, Matschke K, et al. Prolonged intensive care unit stay of patients after cardiac surgery:initial clinical results and follow-up. Thorac Cardiovasc Surg, 2013, 61(8):701-707.
24. Tekumit H, Uzun K, Cenal AR, et al. Determinants of mortality in patients requiring prolonged intensive care unit stay after elective isolated on-pump coronary artery bypass grafting surgery. Kardiol Pol, 2010, 68(3):257-262.
25. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3):691-696.
26. Hein OV, Birnbaum J, Wernecke KD, et al. Intensive care unit stay of more than 14 days after cardiac surgery is associated with non-cardiac organ failure. J Int Med Res, 2006, 34(6):695-703.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive Risk Factors for Prolonged Stay in the Intensive Care Unit after Surgery for Acute Aortic Dissection Type A

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