Predicting Extended ICU Stay Following Coronary Artery Bypass Grafting and its Impact on Hospitalization and Mortality

ICU Stay Prediction After CABG: Impact on Hospitalization and Mortality

Authors

  • Ayah Alkrarha Jordan university of science and technology
  • Majd AlBrakat MD, Associate Professor. Jordan University of Science and Technology /King Abdullah University Hospital/ Division of CardiovascularSurgery/Department of General Surgery/Faculty of Medicine, Irbid, Jordan
  • Walid Hawashin Fifth-year Medical Student. Jordan University of Science and Technology/King Abdullah University Hospital /Faculty of Medicine, Irbid, Jordan
  • Hala Qariouti Fifth-year Medical Student. Jordan University of Science and Technology/King Abdullah University Hospital /Faculty of Medicine, Irbid, Jordan
  • Nizar Alwaqfi MD. Jordan University of Science and Technology/ King Abdullah University Hospital/Department of General Surgery, Irbid, Jordan

Keywords:

CABG, ICU, Hospitalization, Mortality

Abstract

BACKGROUND: Coronary artery bypass grafting (CABG) remains one of the most common surgical treatments for coronary artery disease (CAD), aimed at reducing symptoms and enhancing patient survival. A critical element of post-CABG care is the duration of the patient’s stay in the intensive care unit (ICU), with an ideal target of fewer than 24 hours. However, a range of preoperative, intraoperative, and postoperative factors can extend ICU stays, leading to increased strain on hospital resources, poorer patient outcomes, and higher healthcare costs. This study seeks to identify the key factors that contribute to ICU stays exceeding 48 hours following CABG and CABG combined with heart valve surgery, and to analyze their association with postoperative complications and mortality rates.

METHODS: We conducted a retrospective cohort study at King Abdullah University Hospital (KAUH), analyzing data from 1,395 patients who underwent isolated CABG or CABG combined with valve surgery between January 2004 and December 2022. The patients were categorized into two groups: Group 1, with ICU stays of 48 hours or less (n=1,082), and Group 2, with ICU stays longer than 48 hours (n=313). A comprehensive analysis of clinical, laboratory, and demographic data was performed to identify predictors of prolonged ICU stays. Statistical methods were applied to evaluate the relationship between these factors and the length of ICU stay.

RESULTS: Our analysis revealed that patients in Group 2, who had ICU stays longer than 48 hours, were significantly older, with a mean age of 61.5 years compared to 58.7 years in Group 1 (p<0.001). Several preoperative conditions were strongly associated with prolonged ICU stays, including recent myocardial infarction (OR=1.69, p=0.015), chronic obstructive pulmonary disease (COPD) or asthma (OR=1.49, p=0.003), and preoperative renal impairment (OR=1.89, p=0.002). Intraoperative factors also significantly influenced ICU stay duration, with emergency or urgent surgeries (OR=2.19, p<0.001) and extended ventilator support during surgery (OR=5.92, p<0.001) being the most critical predictors. Postoperative complications emerged as significant determinants of ICU stay length. The development of renal impairment post-surgery (OR=6.78, p<0.001) and the occurrence of pneumonia or sepsis (OR=8.92, p<0.001) were strongly correlated with prolonged ICU stays and were also linked to higher mortality rates.

CONCLUSION: This study highlights the significant role of preoperative comorbidities, intraoperative events, and postoperative complications in prolonging ICU stays after CABG. Extended ICU stays are associated with an increased risk of severe postoperative complications and higher mortality, emphasizing the need for improved surgical and postoperative care protocols. By targeting the identified risk factors, healthcare providers can potentially reduce ICU durations, enhance patient outcomes, and alleviate the burden on healthcare systems. These findings underscore the importance of optimizing ICU resource utilization in the context of cardiac surgery.

Metrics

Metrics Loading ...

References

References.

Shahjehan RD, Bhutta BS. Coronary Artery Disease.; StatPearls Publishing; Jan 2024.

Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA, Michler RE,

Bonow RO, Doenst T, Petrie MC, Oh JK, She L, Moore VL, DesvigneNickens P,

Sopko G, Rouleau JL, Investigators STICHES. Coronary-artery bypass surgery in

patients with ischemic cardiomyopathy. N Engl J Med. 2016;74(16):1511–20

Pimentel MF, Soares MJF, Junior JAM, et al. Predictive Factors of Long-Term Stay in the ICU after Cardiac Surgery: Logistic CASUS Score, Serum Bilirubin Dosage and Extracorporeal Circulation Time. Braz J Cardiovasc Surg. Published online 2017. doi:10.21470/1678-9741-2016-0072

Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged Intensive Care Unit Stay in Cardiac Surgery: Risk Factors and Long-Term-Survival. Ann Thorac Surg. 2006;81(3):880-885. doi:10.1016/j.athoracsur.2005.09.077

Michalopoulos A, Tzelepis G, Pavlides G, Kriaras J, Dafni U, Geroulanos S. Determinants of duration of ICU stay after coronary artery bypass graft surgery. Br J Anaesth. 1996;77(2):208-212. doi:10.1093/bja/77.2.208

Gunnarsdóttir ELT, Gunnarsdóttir SLX, Heimisdóttir AA, et al. The use of Intra Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery. Laeknabladid. 2020;2020(03):123-129. doi:10.17992/lbl.2020.03.471

Almashrafi A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res. 2016;16(1):318. doi:10.1186/s12913-016-1591-3

Wagener G, Minhaz M, Wang S, et al. The Surgical Procedure Assessment (SPA) score predicts intensive care unit length of stay after cardiac surgery. J Thorac Cardiovasc Surg. 2011;142(2):443-450. doi:10.1016/j.jtcvs.2010.09.067

Michalopoulos A, Tzelepis G, Pavlides G, Kriaras J, Dafni U, Geroulanos S. Determinants of duration of ICU stay after coronary artery bypass graft surgery. Br J Anaesth. 1996;77(2):208-212. doi:10.1093/bja/77.2.208

Ibrahim KS, Kheirallah KA, Al Manasra ARA, MegdadiMA. Factors affecting duration of stay in the intensive care unit after coronary artery bypass surgery and its impact on in-hospital mortality: a retrospective study. J Cardiothorac Surg. 2024;19(1):45. doi:10.1186/s13019-024-02527-y

Zarrizi M, Paryad E, Khanghah AG, Leili EK, Faghani H. Predictors of Length of Stay in Intensive Care Unit after Coronary Artery Bypass Grafting: Development a Risk Scoring System. Braz J Cardiovasc Surg. 2021;36(1). doi:10.21470/1678-9741-2019-0405

Silberman S, Bitran D, Fink D, Tauber R, Merin O. Very Prolonged Stay in the Intensive Care Unit After Cardiac Operations: Early Results and Late Survival. Ann Thorac Surg. 2013;96(1):15-22. doi:10.1016/j.athoracsur.2013.01.103

Yeşiler Fİ, Akmatov N, Nurumbetova O, et al. Incidence of and Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery Among Elderly Patients. Cureus. Published online November 17, 2022. doi:10.7759/cureus.31602

Almashrafi A, Alsabti H, Mukaddirov M, Balan B, Aylin P. Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study. BMJ Open. 2016;6(6):e010764. doi:10.1136/bmjopen-2015-010764

Diab MS, Bilkhu R, Soppa G, et al. The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study. J Thorac Cardiovasc Surg. 2018;156(5):1906-1915.e3. doi:10.1016/j.jtcvs.2018.05.076

Downloads

Published

2025-01-01

How to Cite

Alkrarha, A., AlBrakat, M., Hawashin , W., Qariouti, H., & Alwaqfi, N. (2025). Predicting Extended ICU Stay Following Coronary Artery Bypass Grafting and its Impact on Hospitalization and Mortality : ICU Stay Prediction After CABG: Impact on Hospitalization and Mortality . International Journal of Medical Students, 12, S348. Retrieved from https://ijms.pitt.edu/IJMS/article/view/2939

Issue

Vol 12. (2024): Supplement 1

Section

Abstracts of the WCMSR

Categories

License

Copyright (c) 2024 Ayah Alkrarha

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
    2. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
    3. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
    4. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
    5. The Author represents and warrants that:
      1. the Work is the Author’s original work;
      2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
      3. the Work is not pending review or under consideration by another publisher;
      4. the Work has not previously been published;
      5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
      6. the Work contains no libel, invasion of privacy, or other unlawful matter.
    6. The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Enforcement of copyright

The IJMS takes the protection of copyright very seriously.

If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.

If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org

 

Infringing material

If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org