THE USE OF APACHE-III TO EVALUATE ICU LENGTH OF STAY, RESOURCE USE, AND MORTALITY AFTER CORONARY-ARTERY BYPASS-SURGERY

Objective. To identify patient characteristics that are associated wit h increased ICU length of stay, resource use, and hospital mortality a fter coronary artery bypass surgery. Design. Prospective, multicenter study. Setting. Six tertiary care hospitals. Participants. A consecuti ve sample of 2,435 unselected ICU admissions following coronary artery by-pass surgery. Materials and methods. Demographic, operative charac teristics and APACHE III score were collected during the first postope rative day; and APACHE III scores and therapeutic interventions during the first three postoperative days. Hospital survival and ICU length of stay were also recorded. Multivariate equations were derived and cr oss-validated to predict hospital mortality, ICU length of stay, and I CU resource use. Results. Unadjusted hospital mortality rate was 3.9% (range 1.0% to 6.0%), mean ICU length of stay was 3.7 days (range 3.2 to 4.7 days), and first 3-day ICU resource use (TISS points) was 99 (r ange 68 to 116). The range of actual to predicted ICU length of stay v aried from 0.86 to 1.26; and resource use from 0.71 to 1.16. Conclusio ns. A limited number of operative characteristics, the post-operative acute physiology score (APS) of APACHE III and patient demographic dat a can predict hospital death rate, ICU length of stay, and resource us e immediately following coronary by-pass surgery. These estimates may compliment assessments based on pre-operative risk factors in order to more precisely evaluate and improve the efficacy and efficiency of ca rdiovascular surgery.