• Alexander Kogan, Yigal Kassif, Jonathan Frogel, Shany Levin, Eilon Ram, Yael Peled, Ehud Raanani, and Leonid Sternik.
• Department of Cardiac Surgery, Sheba Medical Center, Tel Aviv, Israel; Cardiac Surgery Intensive Care Unit, Sheba Medical Center, Tel Aviv, Israel. Electronic address: Alexander.Kogan@sheba.health.gov.il.
• J. Cardiothorac. Vasc. Anesth. 2021 Aug 1; 35 (8): 2370-2376.

ObjectivesProlonged intensive care unit stay after cardiac surgery is associated with high mortality. The aim of this study was to evaluate the impact of the introduction of a quality improvement program under the supervision of an intensivist on the long-term mortality of high-risk patients with prolonged intensive care unit (ICU) stay after cardiac surgery.DesignRetrospective study of prospectively collected data.SettingCardiac surgery ICU.ParticipantsA total of 7,549 patients after cardiac surgery.InterventionsPatients were divided into two periods: 2004 to 2007, before introducing the quality improvement program (3,315 patients), and 2009 to 2014, after introduction of the program (4,234 patients). In the period from 2004 to 2007, patients were divided into group I (ICU stay ≥ seven days), which included 242 patients, and group III (ICU stay < seven days), which included 3,073 patients. Also, in the period from 2009 to 2014 patients, were divided into group II (ICU stay ≥seven days), which included 326 patients, and group IV (ICU stay < seven days), which included 3,908 patients. Patient outcomes were compared. Follow-up was five years for each group.Measurements And Main ResultsThe European System for Cardiac Operative Risk Evaluation did not differ significantly among the groups. When comparing between group I and group II, 30-day mortality decreased significantly from 24.8% to 16.6%, six-month mortality from 27.3% to 19.3%, one-year mortality from 42.1% to 32.2%, 3-year mortality from 54.5% to 43.3%, and 5-year mortality from 61.2% to 51.8%. In comparing between group III and group IV, the authors did not observe a statistically significant decrease of mortality.ConclusionsIntensivist-led patient management protocol is associated with decreased long-term mortality in high-risk patients with a prolonged ICU stay.Copyright © 2021 Elsevier Inc. All rights reserved.

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