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Second-day discharge from the ICU after non-emergency cardiac surgery

Introduction

To develop models that are discriminative for second-day discharge (SDD) after non-emergency cardiac surgery [1].

Methods

We evaluated electronic medical records of 453 consecutive adult non-emergency cardiac surgery patients, from June 2006 to May 2007. The following variables were considered as inputs: (a) one-time characteristics: sex, age, weekday, BMI, duration of surgery, length of first day; (b) binary variables (yes/no): cardiopulmonary bypass, external pacing, midazolam, hemodynamic drugs; (c) continuous variables: pulmonary artery pressure, arterial blood pressure, heart rate, cardiac output, PaO2, PaCO2, FiO2, creatinine; (d) categorical values: Glasgow coma scale eye–motor–verbal, Bloomsbury score, pain score, positive end-expiratory pressure; (e) averages over time: urine output, blood loss, piritramide and propofol dosage; (f) percentage of time on mechanical ventilation. Variables associated with SDD in univariate analysis were entered into six multivariate logistic regression models. We calculated the area under the receiver operating characteristic curve (aROC) for discrimination; calibration was evaluated by Hosmer–Lemeshow goodness-of-fit.

Results

Ninety-nine patients (21.9%) were discharged on the second day. All models showed good discrimination (aROC = 0.881 to 0.905) and calibration (P > 0.05) (Figure 1). Nine determinants were associated with SDD in all models: sex, age, weekday, hemodynamic drugs, systolic arterial blood pressure, heart rate, verbal Glasgow coma scale, urine output and percentage of time on mechanical ventilation. Entering these nine terms into a combination model could improve discrimination (aROC = 0.933) but led to overfitting (P = 0.0143).

Figure 1
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(abstract P469)

Conclusion

An electronic medical record can be used to create risk prediction models after cardiac surgery. We derived nine parameters associated with SDD.

References

  1. 1.

    Tu JV, et al.: Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation 1995, 91: 677-681.

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Vanfleteren, L., Vandeneynde, P., Vu, T. et al. Second-day discharge from the ICU after non-emergency cardiac surgery. Crit Care 13, P469 (2009). https://doi.org/10.1186/cc7633

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Keywords

  • Mechanical Ventilation
  • Logistic Regression Model
  • Midazolam
  • Arterial Blood Pressure
  • Electronic Medical Record