Markers of length of stay in surgical intensive care unit, in patients submitted to heart surgery

Background

Postoperative management of heart surgery (HS) has been changing in the last decade. `Fast-track strategy' has been proposed, but not for all patients; markers of length of stay (LOS) in surgical intensive care unit (SICU) are still a goal.

Objective

To analyze demographic data, pre-, peri- and postoperative risk stratification factors and scores impact in SICU-LOS, among patients submitted to heart surgery.

Design

Retrospective, consecutive and nonselective observational study.

Setting

Surgical intensive care unit of a tertiary care community hospital.

Methods

All patients submitted to heart surgery at this hospital, from 1 June 2000 to 16 February 2001 were analyzed. Demographic data; preoperative risk stratification factors and scores of American Heart Association score (AHAs), Goldman and Caldera score (GCs), Cleveland Clinic preoperative score (CCs) and European Society of Cardiology score (Es); perioperative times; fluids infusion data; postoperative first day data; and scores of MODS, SOFA and TISS. Correlation/predictive value with SICU LOS were recorded for statistical analysis (multiple linear regretion).

Results

During this period, 211 patients were considered for the study. A total of 207 fulfilled inclusion criteria (had delivered of SICU or died). Forty-eight variables were submitted to statistical analysis. Significant impact in SICU LOS with r = 0.931 and r² = 0.866 in the follow variables show positive predictive value: age (P = 0.0001), GCs (P = 0.0001), combined HS (P = 0.0001), reoperation (P = 0.014), LOS in mechanical ventilation (P = 0.0001); and negative predictive value in the first postoperative (FPO) day creatinine (P = 0.002) and correct by weight fluid imbalance (P = 0.0001).

Discussion

In this small series, we had some interesting information like GCs implication in SICU LOS in HS and negative predictive value fluid imbalance in the FPO. We had strange negative predictive value of creatinine, probably due to the high impact in mortality in these series. Classical information like reoperation, age, LOS in mechanical ventilation and combined HS implication SICU LOS. We shall do a prospective multicentric validation of these findings in the next months, to make a predictive score of SICU-LOS.