FACTORS INFLUENCING LENGTH OF STAY IN THE INTENSIVE CARE UNIT AFTER CORONARY ARTERY BYPASS GRAFT IN DUHOK CITY – KURDISTAN REGION

  • PELAN RAMADHAN HUSSEIN College of Nursing, University of Duhok, Kurdistan Region–Iraq
  • AYAD AHMED MUHAMAD College of Nursing, University of Duhok, Kurdistan Region–Iraq
Keywords: Coronary artery bypass graft, Cardiac intensive care unit, Length of stay, Risk factors, Postoperative complications

Abstract

Background: Long stays in the Intensive Care Unit (ICU) following coronary artery bypass graft (CABG) surgery are associated with higher hospital mortality, poor long-term prognosis, prolonged hospital admissions, and consequently, excessive cost and resource use. This study aimed to identify the individual and perioperative risk factors influencing ICU length of stay after coronary artery bypass graft surgery at Azadi Heart Center in Duhok city.

Patients and Methods: This comparative cross-sectional study reviewed the medical records of 230 patients who underwent CABG surgery from 1st January 2019 to 31st December 2020. The patients were divided into two groups based on their length of stay in the ICU. The usual stay group (ICU length of stay < 72 h), and the prolonged stay group (ICU length of stay ≥ 72 h).

Results: Among the 230 patients studied, 53 (23.04%) patients had an ICU length of stay ≥ 72 hours and 177 (76.96%) patients had an ICU length of stay < 72 hours and the mean duration of ICU stay was 2.45 days, ranging from 1 to 13 days. This study found that the factors increasing the ICU length of stay after CABG were; preoperative myocardial infarction (MI), elevated preoperative WBC counts, prolonged cardiopulmonary bypass (CPB) time, prolonged intubation, reintubation, reoperation, readmission, arrhythmia, receiving inotropic agents in the ICU, cardiac, pulmonary, and wound complications, and a higher postoperative troponin level.

Conclusion: This study showed pre-, intra-, and post-operative clinical and surgical risk factors affect prolonged ICU stays

Downloads

Download data is not yet available.

References

REFRENCES

Almashrafi, A, Elmontsri, M & Aylin, P (2016). Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC health services research, 16(1): 1-12.
Azarfarin, R, Ashouri, N, Totonchi, Z, Bakhshandeh, H & Yaghoubi, A (2014). Factors influencing prolonged ICU stay after open heart surgery. Research in cardiovascular medicine, 3(4).
Bigand, T (2018). NSituation.
Chan, PG, Seese, L, Aranda-Michel, E, Sultan, I, Gleason, TG, Wang, Y, et al. (2021). Operative mortality in adult cardiac surgery: is the currently utilized definition justified? Journal of thoracic disease, 13(10): 5582.
Chen, S, Redfors, B, Liu, Y, Vrolix, M, Macaya, C, Ben-Yehuda, O, et al. (2019). Outcomes of patients with and without baseline lipid-lowering therapy undergoing revascularization for left main coronary artery disease: analysis from the EXCEL trial. Coronary Artery Disease, 30(2): 143-149.
Curtis, JR, Engelberg, RA, Bensink, ME & Ramsey, SD (2012). End-of-life care in the intensive care unit: can we simultaneously increase quality and reduce costs? American journal of respiratory and critical care medicine, 186(7): 587-592.
Diab, M, Bilkhu, R, Soppa, G, McGale, N, Hirani, SP, Newman, SP, et al. (2017). Quality of life in relation to length of intensive care unit stay after cardiac surgery. Journal of cardiothoracic and vascular anesthesia, 31(3): 1080-1090.
Dominici, C, Salsano, A, Nenna, A, Spadaccio, C, Barbato, R, Mariscalco, G, et al. (2020). A nomogram for predicting long length of stay in the intensive care unit in patients undergoing cabg: Results from the multicenter e-cabg registry. Journal of Cardiothoracic and Vascular Anesthesia, 34(11): 2951-2961.
Ganyukov, V, Kochergin, N, Shilov, A, Tarasov, R, Skupien, J, Szot, W, et al. (2020). Randomized clinical trial of surgical vs. percutaneous vs. hybrid revascularization in multivessel coronary artery disease: residual myocardial ischemia and clinical outcomes at one year—Hybrid Coronary Revascularization Versus Stenting or Surgery (HREVS). Journal of Interventional Cardiology, 2020(
Gao, M, Sun, J, Young, N, Boyd, D, Atkins, Z, Li, Z, et al. (2016). Impact of body mass index on outcomes in cardiac surgery. Journal of cardiothoracic and vascular anesthesia, 30(5): 1308-1316.
Gillinov, AM, Gelijns, AC, Parides, MK, DeRose Jr, JJ, Moskowitz, AJ, Voisine, P, et al. (2015). Surgical ablation of atrial fibrillation during mitral-valve surgery. New England Journal of Medicine, 372(15): 1399-1409.
Jarząbek, R, Bugajski, P, Greberski, K, Błaszczyński, J, Słowińska-Jarząbek, B & Kalawski, R (2014). Readmission to an intensive care unit after cardiac surgery: reasons and outcomes. Kardiologia Polska (Polish Heart Journal), 72(8): 740-747.
Jia, S, Liu, Y & Yuan, J (2020). Evidence in guidelines for treatment of coronary artery disease. Coronary Artery Disease: Therapeutics and Drug Discovery: 37-73.
Kao, K-D, Lee, S-YKC, Liu, C-Y & Chou, N-K (2022). Risk factors associated with longer stays in cardiovascular surgical intensive care unit after CABG. Journal of the Formosan Medical Association, 121(1): 304-313.
Kijjanon, K & Deebabanklong, S (2013). A comparison of Length of Hospital Stay and Complications in Patients with On-Pump and off pump Coronary artery bapass Surgery. Ramathibodi Nursing Journal, 17(3): 358-370.
Labata, C, Oliveras, T, Berastegui, E, Ruyra, X, Romero, B, Camara, M-L, et al. (2018). Intermediate care unit after cardiac surgery: impact on length of stay and outcomes. Revista Española de Cardiología (English Edition), 71(8): 638-642.
Mackie, S & Saravanan, P (2021). Postoperative care of the adult cardiac surgical patient. Anaesthesia & Intensive Care Medicine, 22(5): 279-285.
Mahesh, B, Choong, CK, Goldsmith, K, Gerrard, C, Nashef, SA & Vuylsteke, A (2012). Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. The Annals of thoracic surgery, 94(1): 109-116.
Morisaki, A, Hosono, M, Murakami, T, Sakaguchi, M, Suehiro, Y, Nishimura, S, et al. (2016). Effect of negative pressure wound therapy followed by tissue flaps for deep sternal wound infection after cardiovascular surgery: propensity score matching analysis. Interactive cardiovascular and thoracic surgery, 23(3): 397-402.
Oliveira, EKd, Turquetto, ALR, Tauil, PL, Junqueira Jr, LF & Porto, LGG (2013). Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting. Brazilian Journal of Cardiovascular Surgery, 28(353-363.
Osinaike, BB, Okikiolu, B & Olusesin, O (2015). Prolonged intensive care unit stay after coronary artery bypass graft surgery: role of perioperative factors. Nigerian Postgraduate Medical Journal, 22(4): 213.
Perić, VS, Golubović, MD, Lazarević, MV, Kostić, TL, Stokanović, DS, Đorđević, MN, et al. (2021). Predictive potential of biomarkers and risk scores for major adverse cardiac events in elderly patients undergoing major elective vascular surgery. Reviews in Cardiovascular Medicine, 22(3): 1053-1062.
Ralapanawa, U & Sivakanesan, R (2021). Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: A narrative review. Journal of Epidemiology and Global Health, 11(2): 169.
Sadeghi, F, Golitaleb, M, Totonchi, Z, Harorani, M, Azarfarin, R & Bakhshande Abkenar, H (2019). Factors Influencing a Prolonged ICU Stay After Coronary Artery Bypass Graft Surgery: A Cross-sectional Study. Iranian Heart Journal, 20(4): 85-91.
Safarpoor, G, Mohebbi, H, Seifrabyye, MA & Moeinipour, A (2021). Evaluation of the results and complications of posterior pericardiotomy in coronary artery bypass graft surgery at Farshchian Heart center in Hamadan. Journal of Cardio-Thoracic Medicine, 9(2): 810-816.
Tafelski, S, Yi, H, Ismaeel, F, Krannich, A, Spies, C & Nachtigall, I (2016). Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. Journal of infection and public health, 9(5): 577-585.
Tunç, M, Şahutoğlu, C, Karaca, N, Kocabaş, S & Aşkar, FZ (2018). Risk factors for prolonged intensive care unit stay after open heart surgery in adults. Turkish journal of anaesthesiology and reanimation, 46(4): 283.
Wang, C, Jiang, Y, Jiang, X & Chen, S (2021). On-pump beating heart versus conventional on-pump coronary artery bypass grafting on clinical outcomes: a meta-analysis. Journal of Thoracic Disease, 13(7): 4169.
Zarrizi, M, Paryad, E, Khanghah, AG, Leili, EK & Faghani, H (2020). Predictors of length of stay in intensive care unit after coronary artery bypass grafting: development a risk scoring system. Brazilian journal of cardiovascular surgery, 36(57-63.
Zhang, X, Zhang, W, Lou, H, Luo, C, Du, Q, Meng, Y, et al. (2021). Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: A retrospective observational study. International journal of nursing sciences, 8(4): 388-393.
Published
2022-12-07
How to Cite
HUSSEIN, P. R., & MUHAMAD, A. A. (2022). FACTORS INFLUENCING LENGTH OF STAY IN THE INTENSIVE CARE UNIT AFTER CORONARY ARTERY BYPASS GRAFT IN DUHOK CITY – KURDISTAN REGION. Journal of Duhok University, 25(2), 436-450. https://doi.org/10.26682/sjuod.2022.25.2.40
Section
Pure and Engineering Sciences