Outcomes of Patients With Prolonged Intensive Care Unit Length of Stay After Cardiac Surgery

Objective: To determine in-hospital and post-discharge long-term survival in patients with prolonged intensive care unit (ICU) stays after cardiac surgery. Design: Retrospective, cohort study of cardiac surgery patients from May 2007 to June 2012. Setting: Single-center cardiac surgery ICU. Participants: Patients were grouped according to length of ICU stay: between 1 and 2 weeks, between 2 and 4 weeks, and >4 weeks. Interventions: None. Measurements and Main Results: Of 4,963 patients, 3.3%, 1.6%, and 2.9% of patients stayed 1 to 2 weeks, 2 to 4 weeks, and >4 weeks in the ICU, respectively. In-hospital mortality was 11.1%, 26.6%, and 31.0% for patients with 1 to 2 weeks, 2 to 4 weeks, and >4 weeks ICU stay, respectively. Patients with ICU stays between 1 and 2 weeks had 6 months, 1 year, and 2 year survival rates of 84.4%, 80.0%, and 75.3% after discharge, respectively. Patients with ICU stay between 2 and 4 weeks had similar 6 months, 1 year, and 2 year survival rates of 84.7%, 79.9%, and 74.1%, respectively. In contrast, patients with >4 week ICU stays had significantly lower postdischarge survival rates of 63.3%, 56.4%, and 41.1% at 6 months, 1 year, and 2 years, respectively. Postoperative stroke conferred the greatest risk of death within 1 year after discharge (odds ratio 7.6, p = 0.0140). Conclusions: In-hospital mortality rates post-cardiac surgery correlate with length of ICU stay but appear to plateau after 4 weeks. However, a >4 week ICU length of stay confers a worse long-term outcome post-hospital discharge, especially in patients with postoperative stroke. (C) 2016 Elsevier Inc. All rights reserved.