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Predictors, prognosis and costs of prolonged intensive care unit stay after surgery for type A aortic dissection.
Biancari, Fausto; Hérve, Amelié; Peterss, Sven; Radner, Caroline; Buech, Joscha; Pettinari, Matteo; Rodriguez Lega, Javier; Pinto, Angel G; Fiore, Antonio; Onorati, Francesco; Francica, Alessandra; Wisniewski, Konrad; Demal, Till; Conradi, Lenard; Rocek, Jan; Kacer, Petr; Gatti, Giuseppe; Vendramin, Igor; Rinaldi, Mauro; Ferrante, Luisa; Pruna-Guillen, Robert; Quintana, Eduard; DI Perna, Dario; Mariscalco, Giovanni; Jormalainen, Mikko; Field, Mark; Harky, Amer; Dell'aquila, Angelo M; Juvonen, Tatu; Mäkikallio, Timo; Perrotti, Andrea.
Afiliação
  • Biancari F; Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland - faustobiancari@yahoo.it.
  • Hérve A; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland - faustobiancari@yahoo.it.
  • Peterss S; Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France.
  • Radner C; Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
  • Buech J; Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
  • Pettinari M; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
  • Rodriguez Lega J; Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
  • Pinto AG; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
  • Fiore A; Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
  • Onorati F; Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
  • Francica A; Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
  • Wisniewski K; Department of Cardiac Surgery, Henri Mondor University Hospitals, Assistance Publique-Hôpitaux de Paris, Creteil, France.
  • Demal T; Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
  • Conradi L; Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
  • Rocek J; Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
  • Kacer P; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
  • Gatti G; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
  • Vendramin I; Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
  • Rinaldi M; Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
  • Ferrante L; Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
  • Pruna-Guillen R; Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
  • Quintana E; Department of Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
  • DI Perna D; Department of Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
  • Mariscalco G; Department of Cardiovascular Surgery, Clinical Hospital of Barcelona, University of Barcelona, Barcelona, Spain.
  • Jormalainen M; Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
  • Field M; Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
  • Harky A; Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK.
  • Dell'aquila AM; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
  • Juvonen T; Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK.
  • Mäkikallio T; Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, UK.
  • Perrotti A; Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
Minerva Anestesiol ; 90(7-8): 654-661, 2024.
Article em En | MEDLINE | ID: mdl-39021141
ABSTRACT

BACKGROUND:

The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated.

METHODS:

This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU.

RESULTS:

The mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days).

CONCLUSIONS:

Prolonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Mortalidade Hospitalar / Unidades de Terapia Intensiva / Dissecção Aórtica / Tempo de Internação Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Mortalidade Hospitalar / Unidades de Terapia Intensiva / Dissecção Aórtica / Tempo de Internação Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article