Presentation and Outcomes of Patients With Preoperative Critical Illness Undergoing Cardiac Surgery.
Publication/Presentation Date
3-1-2023
Abstract
BACKGROUND: Little is known about the prevalence and post-surgical outcomes associated with cardiac intensive care unit (CICU) therapeutics among CICU patients referred for cardiac surgery.
OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and outcomes of CICU patients referred for cardiac surgery from the intensive care unit.
METHODS: We analyzed characteristics and outcomes of CICU admissions referred from the CICU for cardiac surgery during 2017 to 2020 across 29 centers. The primary outcome was in-hospital mortality.
RESULTS: Among 10,321 CICU admissions, 887 (8.6%) underwent cardiac surgery, including 406 (46%) coronary artery bypass graftings, 201 (23%) transplants or ventricular assist devices, 171 (19%) valve surgeries, and 109 (12%) other procedures. Common indications for CICU admission included shock (33.5%) and respiratory insufficiency (24.9%). Preoperative CICU therapies included vasoactive therapy in 52.2%, mechanical circulatory support in 35.9%, renal replacement in 8.2%, mechanical ventilation in 35.7%, and 17.5% with high-flow nasal cannula or noninvasive positive pressure ventilation. In-hospital mortality was 11.7% among all CICU admissions and 9.1% among patients treated with cardiac surgery. After multivariable adjustment, pre-op mechanical circulatory support and renal replacement therapy were associated with mortality, while respiratory support and vasoactive therapy were not.
CONCLUSIONS: Nearly 1 in 12 contemporary CICU patients receive cardiac surgery. Despite high preoperative disease severity, CICU admissions undergoing cardiac surgery had a comparable mortality rate to CICU patients overall; highlighting the ability of clinicians to select higher acuity patients with a reasonable perioperative risk.
Volume
2
Issue
2
ISSN
2772-963X
Published In/Presented At
Metkus, T. S., Alviar, C. L., Baird-Zars, V. M., Barsness, G. W., Berg, D. D., Bohula, E. A., Burke, J. A., Fordyce, C. B., Guo, J., Katz, J. N., Keeley, E. C., Menon, V., Miller, P. E., O'Brien, C. G., Sinha, S. S., So, D., Ternus, B. W., Vadhar, S., van Diepen, S., & Morrow, D. A. (2023). Presentation and Outcomes of Patients With Preoperative Critical Illness Undergoing Cardiac Surgery. JACC. Advances, 2(2), 100260. https://doi.org/10.1016/j.jacadv.2023.100260
Disciplines
Medicine and Health Sciences
PubMedID
38357248
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article