gms | German Medical Science

Introduction: Readmission to the intensive care unit (ICU) after cardiac surgery is associated with higher costs and impaired clinical outcome. Clinical data and outcome of readmitted patients were analyzed and perioperative prognostic variables of ICU readmission evaluated.

Materials and methods: 5,983 patients who underwent CABG and/or valve or aortic surgery between 2007 and 2009 were reviewed retrospectively. The reasons for readmission and the postoperative course were analyzed. Furthermore, perioperative risk factors for readmission were determined by multivariate regression analysis.

Results: 5,983 patients were discharged from the ICU, 5.6% (335) of these patients required a second stay in the intensive care. The readmission rate was 3.6% following CABG and 7.8% following valve or aortic +/- CABG (p<0.0001). Of the patients who were not readmitted, 3.8% died in hospital, compared to 16.1% in group r (p<0.0001). After readmission, the mean length of stay in hospital was 26.1+/-5.9 days and 12.5+/-5.1 days for all other patients (p<0.05). Main reasons for readmission were respiratory failure (28%) and cardiovascular instability (32%), neurological complications (11%), sepsis (8%), bleeding (12%), abdominal(7%) and renal (7%). Multivariate logistic regression analysis revealed that preoperative renal insufficiency, pulmonary hypertension, reexploration for bleeding, postoperative renal failure and prolonged intubation were independent predictors for readmission.

Conclusion: Readmission to ICU is particular related with valve/combined surgery and associated with impaired outcome. Respiratory and cardiovascular complications were the most common reasons for readmission. Predictive renal and pulmonary risk factors indicate the particular need of preoperative preconditioning and patient selection.