• Shuli Silberman, Daniel Bitran, Daniel Fink, Rachel Tauber, and Ofer Merin.
• Department of Cardiothoracic Surgery, Shaare Zedek Medical Center affiliated with the Hebrew University of Jerusalem, Jerusalem, Israel. ssilberman@szmc.org.il
• Ann. Thorac. Surg. 2013 Jul 1;96(1):15-21; discussion 21-2.

BackgroundProlonged intensive care unit (ICU) stay is a surrogate for advanced morbidity or perioperative complications, and resource utilization may become an issue. It is our policy to continue full life support in the ICU, even for patients with a seemingly grim outlook. We examined the effect of duration of ICU stay on early outcomes and late survival.MethodsBetween 1993 and 2011, 6,385 patients were admitted to the ICU after cardiac surgery. Patients were grouped according to length of stay in the ICU: group 1, 2 days or less (n = 4,631; 73%); group 2, 3 to 14 days (n = 1,423; 22%); group 3, more than 14 days (n = 331; 5%). Length of stay in ICU for group 3 patients was 38 ± 24 days (range, 15 to 160; median 31). Clinical profile and outcomes were compared between groups.ResultsPatients requiring prolonged ICU stay were older, underwent more complex surgery, had greater comorbidity, and a higher predicted operative mortality (p < 0.0001). They had a higher incidence of adverse events and increased mortality (p < 0.0001). Of the 331 group 3 patients, 60% were discharged: survival of these patients at 1, 3, and 5 years was 78%, 65%, and 52%, respectively. Operative mortality as well as late survival of discharged patients was proportional to duration of ICU stay.ConclusionsCurrent technology enables keeping sick patients alive for extended periods of time. Nearly two thirds of patients requiring prolonged ICU leave hospital, and of these, 50% attain 5-year survival. These data support offering full and continued support even for patients requiring very prolonged ICU stay.Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

21 keywords...

hide…