Abstract
The aim of this study was to describe changes in performance indicators such as length of stay [LOS] in the intensive care unit [ICU] and ventilation time, during the last six years in an attempt to identify associations between patient and systemic performance indicators, including the impact of nurse turnover. A retrospective study of prospectively registered data (2013-2018). Propensity- score matching was performed to establish comparable groups. Three Danish university hospitals. The study included a total of 12,404 adult cardiac surgical patients registered in the Western Denmark Heart Registry. The cohort was divided into an "early" group (2013-2016) and a "late" group (2017-2018). An analysis of dynamics in patient indicators and systemic performance indicators, including the impact from selected performance parameters and nurse turnover. Comorbidity, calculated from the European System for Cardiac Operative Risk Evaluation, and the mean age were stable in the study period. Strong predictors of long LOS in the ICU included postoperative use of inotropes, re-exploration surgery, high postoperative drainage, and the "late" time group. Time parameters (relative risks) were all significantly longer in the "late" time group": ventilation time 1.21 (1.05-1.39), length of stay ICU 1.28 (1.11-1.48), and in-hospital time 1.36 (1.19-1.57). ICU nurse turnover increased from four (2013-2014) to 52 (2017-2018). No single patient factor, such as age or comorbidity, could explain the decrease in patient turnover in the ICU. In the same period, the turnover of ICU nurses increased. Patient turnover is complex and affected by a mix of patient and systemic performance factors.
Highlights
An altered balance between demand and resources in cardiac surgery has crafted a challenge for healthcare providers during the last two decades
The use of the American Society of Anesthesiologists (ASA) physical status classification system in the study period increased from 38.3% to 50.6% (p < 0,0001)
This study investigated possible factors that could explain the increases in ventilation times and length of stay (LOS) in the intensive care unit (ICU) in relation to cardiac surgery in the authors’ setting
Summary
An altered balance between demand and resources in cardiac surgery has crafted a challenge for healthcare providers during the last two decades. Various multidisciplinary strategies, including careful selection and extended preoperative patient preparation,[1,2] selection of best suitable procedures,[3,4] application of advanced surgical and anesthetic equipment[3] together with the implementation of different anesthesia and postoperative management protocols,[5,6] were part of the backbone of this development. With its inborn higher frequency of adverse events, commands critical postoperative observation in an intensive care unit (ICU).
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