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Abstract

Introduction: Cardiac-Intensive Care Unit (CICU) readmission is a marker of the quality of care provided by the ICU. CICU re-admission has been reported between 4-14% following all cardiac surgery with mortality rate among these patients being as high as 17%. Patients who deteriorate on the ward are transferred-back early to the CICU in our institution. Methods: Prospectively collected data from all patients who underwent cardiac surgery between 2005 and 2012 (n=7160) was retrieved from our validated database. Patients who required CICU re-admission (Study group, n=152) was matched at a 1:3 ratio to those who did not require CICU readmission (control group, 456) using the 17-factored logistic Euroscore and next neighbour matching. Preoperative characteristics, early postoperative outcome and survival were compared between patients groups. Results: CICU readmission rate was 2.1%. There were no significant differences between the two groups in terms of the pre-op characteristics namely age, pre-op haemoglobin, BMI, gender, ethnic race, history of lung disease, urgency of operation and Logistic Euroscore. The types of operative procedures were similar in both groups. The study group did have more diabetic patients (14.4% v/s 8.8%, p=0.04) and a tendency to more (a) females (28.3 v/s 22.1, p=0.08) and (b) patients with peripheral vascular disease (33.6% v/s 25.7%, p=0.06). Patients who required CICU readmission had higher incidence of re-exploration for bleeding (p<0.01) overall blood transfusion (p=0.01), any infections (including chest infections) (p<0.01), need for renal replacement therapy (p=0.03), atrial fibrillation (p=0.01) and gastro-intestinal complications (<0.01). The most common reasons for CICU readmissions were cardiac (24%) and respiratory problems (36%). The median initial ICU stay was shorter in the study group (2 days v/s 4 days, p<0.01) and the median overall stay was longer in that group (21 days v/s 8 days, p<0.01). Hospital survival, however was not significantly different (89% v/s 93%, p=0.09). Multivariate analysis (age, gender, DM, smoking history, history of lung disease, PVD, ejection fraction, operative urgency, type of cardiac procedure, CPB time, re-exploration for bleeding, day of CICU discharge, duration of first ICU stay, log Euroscore, blood transfusion) showed that the factors associated with CICU re-admission were re-exploration for bleeding (odds ratio 3.8, p<0.01) and a history of peripheral vascular disease (odds ratio 1.5, p=0.05) Conclusions: CICU readmission rate was low in our institution. Predictive factors for re-admission included history of PVD and the need for re-exploration. In this matched cohort, survival of the re-admitted group was similar to the non-re-admitted group possibly reflecting the fact that patients are transferred back to CICU early.