Preoperative prediction of prolonged stay in the intensive care unit for coronary bypass surgery.

OBJECTIVES To construct a predictive model for a prolonged stay in the intensive care unit (ICU) for coronary artery bypass graft surgery (CABG). METHODS Eight hundred and eighty-eight patients undergoing CABG were studied by univariate and multivariate analysis. Prolonged stay in the ICU was defined as >/=3 days stay. Stepwise selective procedure (P</=0.05) was used to identify a subset of variables with prognostic value for prolonged stay. This subset was used to calculate a prognostic score S and predicted probability P (P=1/1+e(-S)). Sensitivity analysis was used for evaluation. RESULTS Significant risk factors for prolonged stay in the ICU were: lung disease, no-sinus rhythm, no-mild valve pathology, reoperation, no-elective operation, and no-off-pump procedure. The receiver operating characteristic curve gave an area under the curve value of 0.68 for prolonged stay in ICU. Observed probabilities compared well with the predicted probabilities. Patients were classified into low (5%), intermediate (15%), high (30%), and very high-risk groups (40%). A predicted probability of >/=0.40 was used as cut-off point for the prognostic test. The specificity of this test for prolonged stay in the ICU was 99%; sensitivity 9%; positive predictive value 60%; and negative predictive value 89%. CONCLUSIONS The results show that individual patients presented for CABG, can be stratified according to their risk for prolonged stay >/=3 days in the ICU.

[1]  S. Lemeshow,et al.  European system for cardiac operative risk evaluation (EuroSCORE). , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[2]  M. Leijala,et al.  Evaluation of the relationship between preoperative risk scores, postoperative and total length of stays and hospital costs in coronary bypass surgery. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[3]  A. Bernstein,et al.  A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. , 1989, Circulation.

[4]  L. Noyez,et al.  Coronary bypass surgery: what is changing? Analysis of 3834 patients undergoing primary isolated myocardial revascularization. , 1998, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[5]  G. Beck,et al.  Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. , 1992, JAMA.

[6]  J. Borrás,et al.  Subjective versus statistical model assessment of mortality risk in open heart surgical procedures. , 1999, Annals of Thoracic Surgery.

[7]  L. Noyez,et al.  Predictors of Nephrological Morbidity after Coronary Artery Bypass Surgery , 2002, Cardiovascular surgery.

[8]  J. Birkmeyer,et al.  Potential reduction in mortality rates using an intensivist model to manage intensive care units. , 2000, Effective clinical practice : ECP.

[9]  Preoperative Prediction of Early Mortality and Morbidity in Coronary Bypass Surgery , 2002 .

[10]  O. Moerer,et al.  Twenty-four hour presence of physicians in the ICU , 2001, Critical care.