gms | German Medical Science

Introduction: Due to a higher number of patients (pts) receiving complex cardiosurgical procedures the proportion of pts with prolonged ICU stay have increased. Information on the clinical outcome but also of the further clinical follow-up of this patient group is restricted Therefore clinical reports of this challenging patient group are of particular clinical interest. We report our experience concerning initial results and follow up in patients with prolonged ICU stay after cardiac surgery.

Materials and methods: A total of 7646 patients underwent CABG and/or valve or aortic surgery in our institution in a 4-year period between January 2007 and December 2010. In a retrospective study clinical data, the postoperative courses as well as the outcome of all pts were recorded. With concern of ICU duration pts were classified in three groups: until 4 days (Group 1, n=6574), more than 4 days (Group 2, n=466) and 7 days (Group 3, n=606). The primary endpoint was the 30-day mortality and the 2-years survival.

Results: Overall 30-days mortality during the study period was 6.8%, being significantly increased in Group 3 compared to Group 2 and 1, 20.9%, 13.4% and 4.8%, respectively (p<0.0001). Prolonged ICU stay was related to a complicated clinical course with a significantly higher incidence on respiratory and renal insufficiency including reintubation, prolonged ventilatory and new onset dialysis (p>0.0001).The 2-years survival was significantly different between the groups, being 85.9% for pts in Group 1, 64.2% for Group 2 and 57.4% for Group 3 (p<0.0001).

Conclusion: The prolonged ICU stay, particularly longer than 7 days is associated with a complicated clinical course and significantly impaired short and 2-years survival following cardiac surgery. Therefore close clinical observation of these high risk patients is warranted in the initial clinical course and further follow-up.