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Prolonged intensive care unit stay after coronary artery bypass graft surgery: Role of perioperative factors

Introduction: Long stay in the Intensive Care Unit (ICU) after coronary artery bypass graft (CABG) surgery has been found to result in increased hospital mortality, poor long-term prognosis, prolonged hospital stay, and consequently, high cost and expenses. We, therefore, reviewed CABG surgery performed at the Madras Medical Mission Chennai, India, during a 3-month period to determine perioperative factors that are significant predictors of prolonged ICU admission. Methods: We retrospectively studied patients who had elective CABG surgery from November 2008 to January 2009. Information about the following perioperative variables were retrieved; patient demographics, history of co-morbid disease, pre-operative left ventricular (LV) function, the number of coronary vessels grafted, duration of bypass, the level of cardiovascular support post-bypass, the need for surgical re-exploration and duration of stay in the ICU. Prolonged ICU admission was defined as stay over 4 days after elective CABG surgery. Results: A total of 194 patients were reviewed, with males accounting for 84%, age ranged from 32 to 80 years, and duration of stay in the ICU from 2 to 14 days, with mean values of 58.06 ± 8.48 years and 3.96 ± 1.60 days, respectively. Univariate analysis showed significant differences in the number of patients with pulmonary hypertension (P = 0.002), mean bypass time (P = 0.018), requirement for LV support with inotrope (P = 0.021) and surgical re-exploration (P = 0.016) when patients with ICU stay ≤4 days were compared to those with stay over 4 days. Multiple regression revealed only LV support (β =0.69; P = 0.003) as the independent predictor of prolonged ICU stay. Conclusion: This review showed LV support with inotrope as the only independent predictor of prolonged ICU stay after CABG surgery. Therefore, an excellent perioperative care leading to a reduced requirement for LV support after cardiopulmonary bypass for CABG surgery should be the goal.