Risk Factors Analysis for the Prolonged Time of ICU Stay after Isolated Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUXian-zeng ¹ , ZHOUTing ¹ , XIEXiao-yong ² ,  LEIBin-feng ² , FENGXu ² , ZHENGBao-shi ²

1. Intensive Care Unit, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
2. Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;

Corresponding author：

LEIBin-feng, Email: binfeng_lei@163.com

Keywords：

Heart valve replacement; Intensive care units; Risk factors

DOI：

10.7507/1007-4848.20160186

Video：

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Objective To analyze the risk factors for the prolonged time of intensive care unit (ICU) stay after isolated heart valve replacement. Method We retrospectively analyzed the clinical data of 400 patients underwent heart valve replacement surgery in our hospital in 2013 year. There were 208 males and 192 females with a mean age of 50.5±11.1 years ranging from 11-85 years. We divided them into an A group with the time of ICU stay shorter than 48 hours and a B group with the time of ICU stay longer than 48 hours. We recorded the demographic characteristics, preoperative data, intraoperative data and postoperative data and analyzed those data with univariate and multivariate methods. Result There was a statictical difference in the demographic characteristics, preoperative data, intraoperative data and postoperative data between the 2 groups (P < 0.05). The logistic result showed that if we didn't consider the postoperative factors the prolonged time of ICU stay statistically related with age over 70 year(OR 2.024, 95%CI 1.182-3.466, P < 0.05), the cardiac grade of New York Heart Association at Ⅲ-Ⅳ(OR 3.295, 95% CI 1.030-10.544, P < 0.05), preoperative hemoglobin concentration less than 120 g/l (OR 0.500, 95%CI 0.263-0.950, P < 0.05), and the cardiopulmonary bypass time more than 180 min (OR 2.486, 95%CI 1.006-6.143, P < 0.05). If we considered the postoperitive factors, the prolonged time of ICU stay statistically linked to the cardiopulmonary bypass time longer than 180 min (OR 3.295, 95% CI 1.030-10.544, P < 0.05), the postoperative blood glucose more than 10 mmol/l (OR 2.954, 95%CI 1.334-6.543, P < 0.05), and the pulling out trachea canula 24 hours after operation (OR 6.742, 95% CI 3.005-15.124, P < 0.05). Conclusion The prolonged time of ICU stay after valve replacement surgery is associated with a number of risk factors before, during and after heart valve replacement surgery. Targeting the risk factors, especially the postoperitive risk factors, can be effective to shorten the ICU residence time.

Citation： XUXian-zeng, ZHOUTing, XIEXiao-yong, LEIBin-feng, FENGXu, ZHENGBao-shi. Risk Factors Analysis for the Prolonged Time of ICU Stay after Isolated Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 773-777. doi: 10.7507/1007-4848.20160186 Copy

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11.	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.
12.	Oliveira EK, Turquetto AL, Tauil PL, et al. Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3):353-363.
13.	Jiao J, Wang M, Zhang J, et al. Procalcitonin as a diagnostic marker of ventilator-associated pneumonia in cardiac surgery patients. Exp Ther Med, 2015, 9(3):1051-1057.
14.	Mahesh B, Choong CK, Goldsmith K, et al. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg, 2012, 94(1):109-116.
15.	Kim C, Connell H, McGeorge A, et al. Prevalence of preoperative anaemia in patients having first-time cardiac surgery and its impact on clinical outcome. A retrospective observational study. Perfusion, 2015, 30(4):277-283.
16.	Cacciatore F, Belluomo AC, Ferrara N, et al. Determinants of prolonged intensive care unit stay after cardiac surgery in the elderly. Aging Clin Exp Res, 2012, 24(6):627-634.
17.	Via MA, Scurlock C, Adams DH, et al. Impaired postoperative hyperglycemic stress response associated with increased mortality in patients in the cardiothoracic surgery intensive care unit. Endocr Pract, 2010, 16(5):798-804.
18.	Cooper DS, Charpie JR, Flores FX, et al. Acute kidney injury and critical cardiac disease. World J Pediatr Congenit Heart Surg, 2011, 2(3):411-423.
19.	王寅, 张平.大左心室心脏瓣膜病心瓣膜置换术后疗效及危险因素分析.中国胸心血管外科临床杂志, 2014, 21(4):440-446.
20.	Ettema RG, Peelen LM, Schuurmans MJ, et al. Prediction models for prolonged intensive care unit stay after cardiac surgery:systematic review and validation study. Circulation, 2010, 122(7):682-689.

1. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9):962-970.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guide-line for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22):2438-2488.
3. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the manage-ment of valvular heart disease (version 2012):the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4):S1-44.
4. Soppa G, Woodford C, Yates M, et al. Functional status and survival after prolonged intensive care unit stay following cardiac surgery. Interact Cardiovasc Thorac Surg, 2013, 16(6):750-754.
5. Bellomo R, Ronco C, Kellum JA, et al. Acute Dialysis Quality Initiative workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care, 2004, 17(3):R204-212.
6. Sá MP, Nogueira JR, Ferraz PE, et al. Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2012, 27(2):217-23.
7. 葛翼鹏, 许建屏, 史艺, 等.心脏瓣膜手术后ICU时间延长的危险因素分析.中国胸心血管外科临床杂志, 2007, 14(2):85-88.
8. Wang C, Zhang GX, Zhang H, et al. Risk model of prolonged intensive care unit stay in Chinese patients undergoing heart valve surgery. Heart Lung Circ, 2012, 21(11):715-724.
9. Lagercrantz E, Lindblom D, Sartipy U. Survival and quality of life in cardiac surgery patients with prolonged intensive care. Ann Thorac Surg, 2010, 89(2):490-495.
10. 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.
11. 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.
12. Oliveira EK, Turquetto AL, Tauil PL, et al. Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3):353-363.
13. Jiao J, Wang M, Zhang J, et al. Procalcitonin as a diagnostic marker of ventilator-associated pneumonia in cardiac surgery patients. Exp Ther Med, 2015, 9(3):1051-1057.
14. Mahesh B, Choong CK, Goldsmith K, et al. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg, 2012, 94(1):109-116.
15. Kim C, Connell H, McGeorge A, et al. Prevalence of preoperative anaemia in patients having first-time cardiac surgery and its impact on clinical outcome. A retrospective observational study. Perfusion, 2015, 30(4):277-283.
16. Cacciatore F, Belluomo AC, Ferrara N, et al. Determinants of prolonged intensive care unit stay after cardiac surgery in the elderly. Aging Clin Exp Res, 2012, 24(6):627-634.
17. Via MA, Scurlock C, Adams DH, et al. Impaired postoperative hyperglycemic stress response associated with increased mortality in patients in the cardiothoracic surgery intensive care unit. Endocr Pract, 2010, 16(5):798-804.
18. Cooper DS, Charpie JR, Flores FX, et al. Acute kidney injury and critical cardiac disease. World J Pediatr Congenit Heart Surg, 2011, 2(3):411-423.
19. 王寅, 张平.大左心室心脏瓣膜病心瓣膜置换术后疗效及危险因素分析.中国胸心血管外科临床杂志, 2014, 21(4):440-446.
20. Ettema RG, Peelen LM, Schuurmans MJ, et al. Prediction models for prolonged intensive care unit stay after cardiac surgery:systematic review and validation study. Circulation, 2010, 122(7):682-689.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Factors Analysis for the Prolonged Time of ICU Stay after Isolated Valve Replacement

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