Determinants of mortality in patients requiring prolonged intensive care unit stay after elective isolated on-pump coronary artery bypass grafting surgery.

BACKGROUND: In up to 36% of patients undergoing cardiac surgery prolonged intensive care unit stay may be necessary. Mortality rates of these patients range from 11% to 94%, causing enormous clinical and ethical issues.

AIM: To identify preoperative, perioperative and postoperative risk factors of mortality in patients with prolonged intensive care unit stay after elective, isolated on-pump coronary artery bypass grafting surgery.

METHODS: Clinical data of 137 patients who underwent an elective, isolated on-pump coronary artery bypass grafting operation, and had an intensive care unit stay of > or = 3 days were retrospectively evaluated. Survivors and non-survivors were compared with regard to preoperative, perioperative and postoperative characteristics to identify the risk factors for mortality.

RESULTS: Multivariate analysis demonstrated that diabetes mellitus (OR = 3.62, 95% CI 1.07-12.26, p = 0.039), postoperative renal dysfunction (OR = 3.86, 95% CI 1.26-11.75, p = 0.018), postoperative intra-aortic balloon pump use (OR = 3.47; 95% CI 1.01-13.24, p = 0.048), prolonged intubation (OR = 3.90, 95% CI 1.19-12.69, p = 0.024) and re-intubation (OR = 14.83, 95% CI 4.35-50.55, p = 0.001) were significant and independent risk factors of mortality.

CONCLUSION: The present study found that the preoperative presence of diabetes mellitus, and postoperative multiorgan failure syndrome decreased the probability of survival in patients with prolonged intensive care unit stay after elective isolated on-pump coronary artery bypass surgery.