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Ann Thorac Surg 2003;76:503-507
© 2003 The Society of Thoracic Surgeons
a Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,
b Department of General Intensive Care, Rabin Medical Center, Beilinson Campus, Petah Tiqva, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Accepted for publication March 4, 2003.
* Address reprint requests to Dr Kogan, Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49 100, Israel
e-mail: akogan{at}clalit.org.il
BACKGROUND: The introduction of "fast-track" management into cardiac surgery has significantly shortened the intensive care unit (ICU) length of stay. Readmission to the ICU, traditionally used as a quality index, has not been investigated in these patients. The aim of this study was to assess the causes, risk factors, and outcomes associated with readmission to the ICU.
METHODS: All patients undergoing open-heart surgery in a tertiary care, university-affiliated center were included in this prospective observational study. Preoperative and intraoperative data as well as ICU outcome were noted in all patients.
RESULTS: Over the 27-month study period,1,613 patients were targeted for fast track management (discharge from ICU on the first postoperative day). The readmission rate was 3.29% (53 patients). Forty-three percent of readmissions occurred within 24 hours of discharge usually because of pulmonary problems (43%) or arrythmias (13%). Readmission was associated with a prolonged ICU stay (105 ± 180.0 versus 19.2 ± 2.4 hours of initial ICU stay) and worse outcome: the only patients who died (6 of 53, 11.3%) were in this group. On multivariate analysis, a Bernstein-Parsonnet risk estimate more than 20 strongly predicted readmission (odds ratio, 3.08; 95% confidence interval, 1.43 to 6.69).
CONCLUSIONS: Among a homogeneous group of patients targeted for fast-track management after cardiac surgery, readmission although uncommon is associated with a longer second ICU stay and significant mortality. The recognition of specific risk factors may allow for appropriate modification of the postoperative course.
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