Unidad de cuidados intermedios tras la cirugía cardiaca: impacto en la estancia media y la evolución clínica / Intermediate care unit after cardiac surgery: impact on length of stay and outcomes

Introducción y objetivos: El posoperatorio de cirugía cardiaca incluye el traslado desde la unidad de cuidados intensivos (UCI) a la sala convencional. Las unidades de cuidados intermedios (UCIn) permiten la optimización de recursos hospitalarios. Se ha analizado el impacto de una UCIn en las estancias medias (en la UCI y hospitalaria) y los resultados (mortalidad hospitalaria y reingresos a los 30 días) tras la cirugía cardiaca (UCIn-CC). Métodos: Desde noviembre de 2012 hasta abril de 2015, ingresaron para cirugía cardiaca 1.324 pacientes consecutivos. Se implementó una UCIn-CC (mayo de 2014). Los pacientes se clasificaron en 2 grupos: pre-UCIn-CC (noviembre de 2012 a abril de 2014; n = 674) y post-UCIn-CC (mayo de 2014 a abril de 2015; n = 650). Resultados: No se observaron diferencias significativas en edad, sexo, factores de riesgo, EuroSCORE 2, fracción de eyección o tipo de cirugía (el 53% valvular, el 26% coronaria, el 11,5% valvular y coronaria y el 1,8% de aorta). La estancia en la UCI disminuyó del pre-UCIn-CC al post-UCIn-CC una media ± desviación estándar de 4,9 ± 11 a 2,9 ± 6 días (p < 0,001); de una mediana [Q1-Q3] de 2 [1-4] a 1 [0-3]; la estancia hospitalaria disminuyó de 13,5 ± 15 a 12,7 ± 11 días (p = 0,01); de 9 [7-13] a 9 [7-11]. No hubo diferencias estadísticamente significativas en la mortalidad intrahospitalaria (4,9 frente al 3,5%; p = 0,28) ni la readmisión a 30 días (4,3 frente al 4,2%; p = 0,89). Conclusiones: Tras la implementación de una UCIn-CC para el cuidado del posoperatorio de cirugía cardiaca, se observó una reducción de las estancias medias en la UCI y hospitalaria, sin que aumentaran la mortalidad hospitalaria ni los reingresos a los 30 días

Introduction and objectives: Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS). Methods: From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n = 674) and post-IMCU-CS (May 2014-April 2015, n = 650). Results: There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9 ± 11 to 2.9 ± 6 days (mean ± standard deviation; P < .001); 2 [1-4] to 1 [0-3] (median [Q1-Q3]); in-hospital length of stay decreased from 13.5 ± 15 to 12.7 ± 11 days (mean ± standard deviation; P = .01); 9 [7-13] to 9 [7-11] (median [Q1-Q3]), in pre-IMCU-CS to post-IMCU-CS, respectively. There were no statistically significant differences in in-hospital mortality (4.9% vs 3.5%; P = .28) or 30-day readmission rate (4.3% vs 4.2%; P = .89). Conclusions: After the establishment of an IMCU-CS for postoperative cardiac surgery, there was a reduction in ICU and in-hospital mean lengths of stay with no increase in in-hospital mortality or 30-day readmissions

Intermediate Care Unit After Cardiac Surgery: Impact on Length of Stay and Outcomes.

INTRODUCTION AND OBJECTIVES: Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS). METHODS: From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n=674) and post-IMCU-CS (May 2014-April 2015, n=650). RESULTS: There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9±11 to 2.9±6 days (mean±standard deviation; P<.001); 2 [1-4] to 1 [0-3] (median [Q1-Q3]); in-hospital length of stay decreased from 13.5±15 to 12.7±11 days (mean±standard deviation; P=.01); 9 [7-13] to 9 [7-11] (median [Q1-Q3]), in pre-IMCU-CS to post-IMCU-CS, respectively. There were no statistically significant differences in in-hospital mortality (4.9% vs 3.5%; P=.28) or 30-day readmission rate (4.3% vs 4.2%; P=.89). CONCLUSIONS: After the establishment of an IMCU-CS for postoperative cardiac surgery, there was a reduction in ICU and in-hospital mean lengths of stay with no increase in in-hospital mortality or 30-day readmissions.