Predictors analysis of ICU readmission after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Cheng , GE Min , CHEN Tao , LU Lichong ,  WANG Dongjin

Department of Cardiac and Thoracic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, P.R.China;

Corresponding author：

WANG Dongjin, Email: gldjw@163.com

Keywords：

Cardiac surgery; readmission; intensive care unit

DOI：

10.7507/1007-4848.201611033

Video：

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Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.

Citation： CHEN Cheng, GE Min, CHEN Tao, LU Lichong, WANG Dongjin. Predictors analysis of ICU readmission after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 522-526. doi: 10.7507/1007-4848.201611033 Copy

1.	van Sluisveld N, Bakhshi-Raiez F, de Keizer N, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res, 2017, 17(1): 281.
2.	Litwinowicz R, Bartus K, Drwila R, et al. In-hospital mortality in cardiac surgery patients after readmission to the intensive care unit: a single-center experience with 10,992 patients. J Cardiothorac Vasc Anesth, 2015, 29(3): 570-575.
3.	Kang YA. Risk factors and outcomes associated with readmission to the Intensive Care Unit after cardiac surgery. AACN Adv Crit Care, 2016, 27(1): 29-39.
4.	Saharan S, Legg AT, Armsby LB, et al. Causes of readmission after operation for congenital heart disease. Ann Thorac Surg, 2014, 98(5): 1667-1673.
5.	Jarzabek R, Bugajski P, Greberski K, et al. Readmission to an intensive care unit after cardiac surgery: reasons and outcomes. Kardiol Pol, 2014, 72(8): 740-747.
6.	Magruder JT, Kashiouris M, Grimm JC, et al. A predictive model and risk score for unplanned cardiac surgery Intensive Care Unit readmissions. J Card Surg, 2015, 30(9): 685-690.
7.	Benetis R, Sirvinskas E, Kumpaitiene B, et al. A case-control study of readmission to the intensive care unit after cardiac surgery. Med Sci Monit, 2013, 19: 148-152.
8.	van Diepen S, Graham MM, Nagendran J, et al. Predicting cardiovascular intensive care unit readmission after cardiac surgery: derivation and validation of the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) cardiovascular intensive care unit clinical prediction model from a registry cohort of 10,799 surgical cases. Crit Care, 2014, 18(6): 651.
9.	Giakoumidakis K, Eltheni R, Patelarou A, et al. Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece. Ann Thorac Med, 2014, 9(1): 8-13.
10.	Szelkowski LA, Puri NK, Singh R, et al. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg, 2015, 52(1): 531-569.
11.	Blitz JD, Shoham MH, Fang Y, et al. Preoperative renal insufficiency: underreporting and association with readmission and major postoperative morbidity in an academic medical center. Anesth Analg, 2016, 123(6): 1500-1515.
12.	Joskowiak D, Wilbring M, Szlapka M, et al. Readmission to the intensive care unit after cardiac surgery: a single-center experience with 7105 patients. J Cardiovasc Surg (Torino), 2012, 53(5): 671-676.
13.	Manji RA, Arora RC, Singal RK, et al. Long-term outcome and predictors of noninstitutionalized survival subsequent to prolonged intensive care unit stay after cardiac surgical procedures. Ann Thorac Surg, 2016, 101(1): 56-63.
14.	Exarchopoulos T, Charitidou E, Dedeilias P, et al. Scoring systems for outcome prediction in a cardiac surgical intensive care unit: a comparative study. Am J Crit Care, 2015, 24(4): 327-335.
15.	Frost SA, Alexandrou E, Bogdanovski T, et al. Severity of illness and risk of readmission to intensive care: a meta-analysis. Resuscitation, 2009, 80(5): 505-510.
16.	Nates JL, Nunnally M, Kleinpell R, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med, 2016, 44(8): 1553-1602.
17.	Toraman F, Senay S, Gullu U, et al. Readmission to the intensive care unit after fast-track cardiac surgery: an analysis of risk factors and outcome according to the type of operation. Heart Surg Forum, 2010, 13(4): E212-E217.
18.	Choudhary R, Iqbal N, Khusro F, et al. Heart failure biomarkers. J Cardiovasc Transl Res, 2013, 6(4): 471-484.
19.	Cagini L, Andolfi M, Leli C, et al. B-type natriuretic peptide following thoracic surgery: a predictor of postoperative cardiopulmonary complications. Eur J Cardiothorac Surg, 2014, 46(5): e74-e80.

1. van Sluisveld N, Bakhshi-Raiez F, de Keizer N, et al. Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices. BMC Health Serv Res, 2017, 17(1): 281.
2. Litwinowicz R, Bartus K, Drwila R, et al. In-hospital mortality in cardiac surgery patients after readmission to the intensive care unit: a single-center experience with 10,992 patients. J Cardiothorac Vasc Anesth, 2015, 29(3): 570-575.
3. Kang YA. Risk factors and outcomes associated with readmission to the Intensive Care Unit after cardiac surgery. AACN Adv Crit Care, 2016, 27(1): 29-39.
4. Saharan S, Legg AT, Armsby LB, et al. Causes of readmission after operation for congenital heart disease. Ann Thorac Surg, 2014, 98(5): 1667-1673.
5. Jarzabek R, Bugajski P, Greberski K, et al. Readmission to an intensive care unit after cardiac surgery: reasons and outcomes. Kardiol Pol, 2014, 72(8): 740-747.
6. Magruder JT, Kashiouris M, Grimm JC, et al. A predictive model and risk score for unplanned cardiac surgery Intensive Care Unit readmissions. J Card Surg, 2015, 30(9): 685-690.
7. Benetis R, Sirvinskas E, Kumpaitiene B, et al. A case-control study of readmission to the intensive care unit after cardiac surgery. Med Sci Monit, 2013, 19: 148-152.
8. van Diepen S, Graham MM, Nagendran J, et al. Predicting cardiovascular intensive care unit readmission after cardiac surgery: derivation and validation of the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) cardiovascular intensive care unit clinical prediction model from a registry cohort of 10,799 surgical cases. Crit Care, 2014, 18(6): 651.
9. Giakoumidakis K, Eltheni R, Patelarou A, et al. Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece. Ann Thorac Med, 2014, 9(1): 8-13.
10. Szelkowski LA, Puri NK, Singh R, et al. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg, 2015, 52(1): 531-569.
11. Blitz JD, Shoham MH, Fang Y, et al. Preoperative renal insufficiency: underreporting and association with readmission and major postoperative morbidity in an academic medical center. Anesth Analg, 2016, 123(6): 1500-1515.
12. Joskowiak D, Wilbring M, Szlapka M, et al. Readmission to the intensive care unit after cardiac surgery: a single-center experience with 7105 patients. J Cardiovasc Surg (Torino), 2012, 53(5): 671-676.
13. Manji RA, Arora RC, Singal RK, et al. Long-term outcome and predictors of noninstitutionalized survival subsequent to prolonged intensive care unit stay after cardiac surgical procedures. Ann Thorac Surg, 2016, 101(1): 56-63.
14. Exarchopoulos T, Charitidou E, Dedeilias P, et al. Scoring systems for outcome prediction in a cardiac surgical intensive care unit: a comparative study. Am J Crit Care, 2015, 24(4): 327-335.
15. Frost SA, Alexandrou E, Bogdanovski T, et al. Severity of illness and risk of readmission to intensive care: a meta-analysis. Resuscitation, 2009, 80(5): 505-510.
16. Nates JL, Nunnally M, Kleinpell R, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med, 2016, 44(8): 1553-1602.
17. Toraman F, Senay S, Gullu U, et al. Readmission to the intensive care unit after fast-track cardiac surgery: an analysis of risk factors and outcome according to the type of operation. Heart Surg Forum, 2010, 13(4): E212-E217.
18. Choudhary R, Iqbal N, Khusro F, et al. Heart failure biomarkers. J Cardiovasc Transl Res, 2013, 6(4): 471-484.
19. Cagini L, Andolfi M, Leli C, et al. B-type natriuretic peptide following thoracic surgery: a predictor of postoperative cardiopulmonary complications. Eur J Cardiothorac Surg, 2014, 46(5): e74-e80.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictors analysis of ICU readmission after cardiac surgery

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