Surgical ICU recidivism after cardiac operations

Background: Decreasing the ICU length of stay (LOS) after cardiac operation s may increase ICU recidivism, obviating the benefit of early discharge. Methods: From January 1, 1994 to January 1, 1998, there were 2,388 consecut ive cardiac operations, from which 2,228 patients were discharged alive fro m the ICU and had sufficient information to determine their incidence of IC U return, the reasons for their return, their ICU LOS (initial and secondar y LOS), and mortality. Results: A decrease occurred in the initial ICU LOS from 1994 through 1997 (medians for 1994, 1995, 1996, and 1997, respectively: 31 h, 26.4 h, 24.5 h , and 24 h; and means, respectively: 69.4 +/- 139.8, 62.8 +/- 114.1, 52.5 /- 104.0, and 56.2 +/- 103.4 h; p = 0.048). In association with this, howev er, ICU recidivism increased (as percentage of discharges, respectively: 3. 9%, 4.2%, 6.1%, and 8.4%; p = 0.005). Inclusive of secondary ICU LOS, the t otal ICU LOS hours still decreased over the 4-year period. Most notably, th e incidence of readmission increased with longer initial LOS (initial LOS q uartiles from shortest to longest: 3.9%, 5.2%, 4.7%, and 9.2%; p = 0.0008). Predictors of ICU recidivism included preoperatively; a history of congest ive heart failure, and a lower mean left ventricular ejection fraction (52. 7 +/- 19.3% vs 49.8 +/- 21.5%; p = 0.0080); and, postoperatively, an increa sed mean weight gain (8.5 +/- 5.6 kg vs 10.3 +/- 4.7 kg; p = 0.040) and lon ger mean initial ventilator time (157 +/- 299 h vs 35 +/- 107 h; p = 0.038) . The most common reason for readmission was pulmonary problems. Conclusions: Over the years studied, the initial ICU LOS after cardiac oper ations has decreased in association with a significant increase in ICU reci divism. Importantly, however, patients readmitted to the ICU are those with longer initial LOSs. Decreased initial stay does not account for our incre ased ICU recidivism, and efforts to decrease ICU recidivism can focus on th e patients with poor preoperative cardiac function and longer initial ICU s tays.