Original article
Clinical Predictors for Prolonged Intensive Care Unit Stay in Adults Undergoing Thoracic Aortic Surgery Requiring Deep Hypothermic Circulatory Arrest

https://doi.org/10.1053/j.jvca.2005.07.031Get rights and content

Objective: The purpose of this study was to describe clinical predictors for prolonged length of stay in the intensive care unit (PLOS-ICU) after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA); and to determine the incidence of PLOS-ICU after DHCA, univariate predictors for PLOS-ICU, and multivariate predictors for PLOS-ICU.

Study Design: A retrospective and observational study. PLOS-ICU was defined as longer than 5 days in the ICU.

Study Setting: Cardiothoracic operating rooms and the ICU.

Participants: All adults requiring thoracic aortic repair with DHCA

Interventions: None.

Main Results: The cohort size was 144. The incidence of PLOS-ICU was 27.8%. The mortality rate was 11.1%. Univariate predictors for PLOS-ICU were age, stroke, DHCA duration, vasopressor dependence >72 hours, mediastinal re-exploration for bleeding, and renal dysfunction. Multivariate predictors for PLOS-ICU were stroke, vasopressor dependence >72 hours, and renal dysfunction.

Conclusions: PLOS-ICU after DHCA is common. The identified multivariate predictors merit further hypothesis-driven research to enhance perioperative protection of the brain, kidney, and cardiovascular system.

Section snippets

Methods

After obtaining institutional review board approval, all adults undergoing DHCA-TAS in 2000 and 2001 at the Hospital of the University of Pennsylvania were included in the study. The medical records were abstracted in a standardized fashion. The patient data were entered in predefined data fields (Microsoft Access; Microsoft, Seattle, WA) by trained study personnel. Each abstracted patient data set was subsequently reviewed by the study investigators, including a neurologist, who are all very

Results

The preoperative cohort summary is presented in Table 1. The average age was 64.7 years. There was no significant difference in sex. Antifibrinolytic exposure was 100%: 65.9% aprotinin and 34.1% aminocaproic acid. Both antifibrinolytic groups were similar (p > 0.05) except for emergency cases (aprotinin 24.5%, aminocaproic acid 3.6%, p < 0.05) and reoperation cases (arotinin 13.6%, aminocaproic acid 1.8%, p < 0.05).

The breakdown of surgical procedures is summarized in Table 2, Table 3.

Discussion

This clinical trial has examined a large adult DHCA-TAS cohort to characterize PLOS-ICU with respect to incidence and clinical predictors. The incidence of PLOS-ICU, as defined, is 27.8%. The first question is whether the definition of PLOS-ICU is too strict for DHCA-TAS, a very extensive cardiovascular procedure. This question is relevant but difficult to answer at this point because the current literature is focused on mortality and stroke and not on length of stay in the ICU for DHCA-TAS.26,

Conclusion

Prolonged ICU stay after DHCA-TAS is still common and is mostly related to perioperative injury to the brain, cardiovascular system, and kidney. Further evidence-based research is required to define robust perioperative predictors for these organ-based injuries so that hypothesis-driven perioperative interventions may be tested to improve perioperative patient outcome.

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