Abstract
Objective: An increasing number of elderly and multi-morbid patients undergo cardiac surgery which results in increased postoperative morbidity, prolonged Intensive Care Unit (ICU) length of stay (LOS) and higher hospital costs. We aimed to evaluate the model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the prediction of ICU LOS, hospital LOS, required daily nursing effort, and the type of cardiac rehabilitation. Methods: Prospective observational evaluation of 505 consecutive adult patients (mean age 65.1 ± 12.1 years, 25.7% female) who underwent cardiac and/or thoracic aortic thoracic surgery with Cardiopulmonary Bypass (CPB). Results: Median additive and logistic EuroSCORE was 5 (Interquartile Range (IQR) 3-7) and 5.8 (IQR 2.6-14.1), respectively. In univariate analysis both additive and logistic EuroSCORE were significantly associated with prolonged ICU LOS, prolonged hospital LOS, higher daily nursing effort, and the type of cardiac rehabilitation (inpatient versus outpatient), p<0.001 for all correlations. Multivariate analysis including other clinically relevant variables (CPB duration, type of operation, age, Body Mass Index (BMI), urgency of surgery, Left Ventricular Ejection Fraction (LVEF)) showed higher additive EuroSCORE and higher logistic EuroSCORE, independently associated with prolonged ICU LOS, prolonged hospital LOS, and higher daily nursing effort. However, EuroSCORE did not independently predict the type of rehabilitation. Conclusion: The EuroSCORE model can be used to identify patients with elevated risk for prolonged ICU LOS, prolonged hospital LOS and higher intensity of postoperative workload, and it is predictive for the type of rehabilitation. This conclusion may contribute to optimize the management of hospital bed capacity as well as a systematic planning of ICU resources, postoperative nursing care and cardiac rehabilitation.
Highlights
Patients profile in cardiac surgery has considerably changed over the last 25 years [1]
The EuroSCORE model can be used to identify patients with elevated risk for prolonged Intensive Care Unit (ICU) length of stay (LOS), prolonged hospital LOS and higher intensity of postoperative workload, and it is predictive for the type of rehabilitation
This conclusion may contribute to optimize the management of hospital bed capacity as well as a systematic planning of ICU resources, postoperative nursing care and cardiac rehabilitation
Summary
Patients profile in cardiac surgery has considerably changed over the last 25 years [1]. Despite the increasing number of elderly and multi-morbid patients, in-hospital mortality in cardiac surgery remained unchanged or could be reduced [1]. A higher rate of postoperative morbidity is associated with prolonged ICU LOS and, in this clinical setting, with a remarkable increase of individual health care costs per patient [2,3,4]. Optimal utilization of a hospital’s resources becomes more and more important. Prediction of ICU LOS and hospital LOS are decisive information for a hospital’s management to allocate resources and to estimate hospital costs. Estimation of intensity of postoperative nursing care during hospitalization allows calculation of required human resources for adequate nursing in a specified patient population. Preoperative prediction of the appropriate type of rehabilitation is desirable for an optimal planning of the entire therapeutic concept
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