The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study.

OBJECTIVE: To examine the influence of prolonged intensive care unit (ICU) stay on quality of life and recovery following cardiac surgery. METHODS: Quality of life was assessed using the Short Form 36 Health Survey (SF36). The Postoperative Quality of Recovery Scale was used to assess quality of recovery, disability, and cognition after ICU discharge over 12 months' follow-up. Prolonged ICU stay was defined as ≥3 postoperative days. Mortality and major adverse cardiac and cerebrovascular events were recorded up to 12 months. RESULTS: For quality of life, the physical component improved over time in both groups (P < .01 for both groups), as did the mental component (P < .01 for both groups). The long ICU group had lower physical and mental components over time (both P values < .01), but by 12 months the values were similar. The overall quality of recovery was lower for the long ICU group (P < .01). Likewise, we found higher rates of recovery in the normal ICU group than in the long ICU group in terms of emotive recovery (P < .01), activities of daily living (P < .01), and cognitive recovery (P = .03) but no differences in terms of physiologic (P = .91), nociceptive (P = .89), and satisfaction with anesthetic care (P = .91). Major adverse cardiac and cerebrovascular events (P < .01), 30-day mortality (P < .01), and length of ward stay (P < .01) were all higher with prolonged ICU stay. CONCLUSIONS: Patients with prolonged ICU stay have lower quality of life scores; however, they achieve similar midterm quality of recovery, but with reduced survival, increased major adverse cardiac and cerebrovascular events, and longer hospital length of stay.

Acute right atrial and pulmonary artery bone cement mass emboli following vertebroplasty.

Cardiac and pulmonary artery emboli are lethal complications following vertebroplasty. Clinicians should recognise these fatal complications immediately and surgical extraction is mandatory and provides the best outcome.

Cardiac sarcoma presenting with abdominal pain and mimicking myxoma on echocardiogram.

Cardiac sarcoma's are highly aggressive tumours. Clear resection margins ± autotransplant, followed by chemotherapy, offers the best survival chance. Therefore, frozen section should be preformed when there is ambiguity in diagnosis.