Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study

• Published in: BMJ open 2016-06, Vol.6 (6), p.e010764-e010764
• Main Authors: Almashrafi, Ahmed, Alsabti, Hilal, Mukaddirov, Mirdavron, Balan, Baskaran, Aylin, Paul
• Format: Article
• Language: English
• Subjects: Age; Aged; Body mass index; Cardiac arrhythmia; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - classification; Cardiopulmonary Bypass; Cerebrovascular disease; Coronary vessels; Diabetes; Ejection fraction; Elective surgery; Female; Heart surgery; Hospitals; Humans; Intensive Care Units; Length of stay; Length of Stay - statistics & numerical data; Logistic Models; Male; Middle Aged; Oman; Patients; Postoperative Complications - epidemiology; Postoperative Period; Pulmonary hypertension; Referral and Consultation; Respiratory diseases; Retrospective Studies; Risk Factors; Surgery; Variables
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010764

ObjectivesTwo objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems.DesignObservational retrospective study.SettingsA tertiary hospital in Oman.ParticipantsAll adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013.Results30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS.ConclusionsPatient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals.