• Rajesh Bhavsar and Carl-Johan Jakobsen.
• Surgery and Intensive Care East, Aarhus University Hospital, Aarhus, Denmark.
• J. Cardiothorac. Vasc. Anesth. 2020 Jun 1; 34 (6): 1476-1484.

ObjectiveTo identify dynamics of associations and potential areas for optimization of patient turnover between various patient profile and comorbidity indicators and selected system performance indicators such as ventilation time, length of stay in the intensive care unit, and in-hospital stay.DesignRetrospective study of prospectively registered data (2000-2017).SettingThree university hospitals.ParticipantsThe study comprised 38,100 adult cardiac surgical patients registered in the Western Denmark Heart Registry.InterventionsAnalysis of dynamics in patient indicators and system performance indicators, including effect on the selected performance parameters.Measurements And Main ResultsComorbidity, calculated from EuroSCORE, decreased from 2.5 ± 2.2 to 1.5 ± 2.0 (p < 0.001), whereas the average age of patients increased from 65.1 ± 9.9 years to 67.6 ± 10.8 years (p < 0.001). Median ventilation time decreased from 380 to 275 minutes (p < 0.0001). The mean length of stay in the intensive care unit demonstrated a statistically significant decrease from 35.1 hours between 2000 to 2002 to 31.8 hours between 2015 to 2017 (p = 0.004), and the median time was unchanged at 22.0 hours throughout the observation period. The median in-hospital stay decreased from 6.5 to 5.1 days (p < 0.001) and the mean in-hospital stay from 8.7 days (2003-2005) to 7.0 days (2015-2017; p < 0.001). Logistic regression analysis of performance factors showed a statistically significant negative independent effect on most comorbidity and surgical factors.ConclusionThe increase in performance parameters appears to be highly associated with decreased comorbidities and fast-tracking protocols and may only offer limited effect in additional patient turnover.Copyright © 2019 Elsevier Inc. All rights reserved.

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