Perioperative Risk Factors for Intensive Care Unit Readmissions and Mortality After Cardiac Surgery.

OBJECTIVE: The aim of this study was to identify perioperative risk factors associated with intensive care unit readmission and in-hospital death after cardiac surgery. DESIGN: Retrospective analysis using a multivariate regression model to identify independent risk factors for intensive care unit [ICU] readmission and in-hospital mortality. SETTING: The study was carried out in a single tertiary-care hospital. PARTICIPANTS: This was an analysis of 2,789 adult patients. INTERVENTIONS: All patients underwent cardiac surgery and were admitted to the intensive care unit perioperatively at the General Hospital Vienna. MEASUREMENTS AND MAIN RESULTS: Among the 2,789 patients included in the analysis, 167 (6%) were readmitted to the intensive care unit during the same hospital stay. Preoperative risk factors associated with ICU readmission included end-stage renal failure (odds ratio [OR] 2.80, 95% CI: 1.126-6.964), arrhythmia (OR 1.59, 95% CI: 1.019-2.480), chronic obstructive pulmonary disease (OR 1.51, 95% CI: 1.018-2.237), age >80 (OR 2.55, 95% CI: 1.189-5.466), and European System for Cardiac Operative Risk Evaluation II >8 (OR 1.40, 95% CI: 1.013-1.940). Readmitted patients were more likely to die than nonreadmitted patients (OR 5.3, 95% CI: 3.284-8.558). In-hospital mortality in readmitted patients was 19.2%, whereas that in the nonreadmitted study population was 5.1%. CONCLUSION: Preoperative risk assessment is crucial for identifying cardiac surgery patients at risk of ICU readmission and in-hospital death. The potentially modifiable risk factors pinpointed by this study call for the optimization of care before surgery and after ICU discharge.

Acute coronary syndrome in immigrants and non-immigrants : Results of an Austrian prospective pilot study.

BACKGROUND: There are indications that immigrant patients with acute coronary syndrome (ACS) differ in demographic characteristics and clinical presentation from non-immigrant patients. The aim of this prospective pilot study was to gather clinical and sociodemographic data from patients with ACS and to compare immigrants with non-immigrants. METHODS: Included were consecutive patients who underwent acute coronary angiography in one cardiological department for ACS from September 2011 to September 2013. Information was gathered about age, sex, results of the coronary angiography, classical risk factors, socioeconomic characteristics as well as ethnicity. Patients who had their place of birth outside Austria were specified as immigrants. RESULTS: A total of 100 patients (29% female) with a mean age of 60 years (range 34-91 years) were included. Of the patients 35 (35%) were immigrants, 12 came from Serbia, 4 from Bosnia, 3 from South America, 2 from Germany, 2 from Turkey, 2 from the Czech Republic, 2 from Croatia, 2 from Macedonia, and 1 each from Bangladesh, Poland, Romania, Libya, Bulgaria and Pakistan. Immigrants tended to be younger on average (56 vs. 62 years, p = 0.04) and had a two or multivessel disease more often than the non-immigrants but this difference was not significant (51% vs. 38%, p = 0.29). There were no differences between non-immigrants and immigrants concerning the classical risk factors for ACS (hypercholesterinemia 60% vs. 69%, nicotine abuse 51% vs. 60%, hypertension 69% vs. 79%) except diabetes mellitus (15% vs. 37%, p = 0.02). Sociodemographic data showed differences in education and socioeconomic status (SES). Non-immigrants had jobs with high skill level more often than immigrants (30% vs. 4%, p = 0.02), although there was no difference between immigrants and non-immigrants in the level of high education (9% each); however, immigrants more often had low education (31% vs. 11%, p = 0.01) and a monthly income below 1000 € than non-immigrants (41% vs. 14%, p = 0.03). CONCLUSIONS: Immigrants with ACS suffered more often from coronary two or multivessel disease and diabetes mellitus and were slightly younger than non-immigrants, although they did not differ regarding classical risk factors. Results suggest that the lower SES of immigrants compared with non-immigrants might contribute to the severity of coronary heart disease.