Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- 47 Routine management after cardiac surgery
- 48 Management after coronary artery bypass grafting surgery
- 49 Management after valve surgery
- 50 Management after aortic surgery
- 51 Management after thoracic surgery
- 52 Lung volume reduction surgery
- 53 Chronic thromboembolic pulmonary hypertension and pulmonary endarterectomy
- 54 Oesophagectomy
- 55 Management after heart transplant
- 56 Management after lung transplant
- 57 Prolonged critical care stay after cardiac surgery
- 58 Palliative care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
57 - Prolonged critical care stay after cardiac surgery
from SECTION 4 - Procedure-Specific Care in Cardiothoracic Critical Care
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- 47 Routine management after cardiac surgery
- 48 Management after coronary artery bypass grafting surgery
- 49 Management after valve surgery
- 50 Management after aortic surgery
- 51 Management after thoracic surgery
- 52 Lung volume reduction surgery
- 53 Chronic thromboembolic pulmonary hypertension and pulmonary endarterectomy
- 54 Oesophagectomy
- 55 Management after heart transplant
- 56 Management after lung transplant
- 57 Prolonged critical care stay after cardiac surgery
- 58 Palliative care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
With advances in surgical and anaesthetic practice, the majority of patients undergoing cardiac surgery spend less than 24 hours in critical care. However, a proportion (between 4.8% and 16%) are admitted for longer than 5 days. This is more likely in the increasingly prevalent older patient population, who often have comorbidities. In addition, the development of less invasive surgery has permitted higher risk patients to be accepted for surgery.
For patients with a complicated critical care stay, surgical mortality in terms of 30-day or in-hospital mortality only partially reflects the overall outcome. Longer term mortality and morbidity provide a better analysis of the benefit of surgery.
Mortality
In the mid 1990s, authors began to examine the long-term mortality of cardiac surgical patients requiring prolonged critical care treatment. A number of studies have been published. In these studies, long-stay patients represented around 5% of those who underwent cardiac surgery, but accounted for 50% of the hospital critical care days and consumed 48% of the total critical care resources and 23% of the hospital direct costs. Early mortality (within 10 days) appears related to the patient risk profile and to the type of operation performed. A late increase in mortality is noted for those patients remaining in critical care, which is due to complications such as ventilator-associated pneumonia and sepsis.
- Type
- Chapter
- Information
- Core Topics in Cardiothoracic Critical Care , pp. 417 - 424Publisher: Cambridge University PressPrint publication year: 2008