Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:638-42 - Vol. 71 Num.08 DOI: 10.1016/j.rec.2017.10.018

Intermediate Care Unit After Cardiac Surgery: Impact on Length of Stay and Outcomes

Carlos Labata a,, Teresa Oliveras a, Elisabet Berastegui b, Xavier Ruyra b, Bernat Romero b, Maria-Luisa Camara b, Maria-Soledad Just c, Jordi Serra a, Ferran Rueda a, Marc Ferrer a, Cosme García-García a, Antoni Bayes-Genis a,d

a Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
b Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
c Servicio de Medicina Intensiva, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
d Instituto de Investigación en Ciencias de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain

Keywords

Intermediate care unit. Cardiac surgery. Postoperative care.

Abstract

Introduction and objectives

Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS).

Methods

From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n = 674) and post-IMCU-CS (May 2014-April 2015, n = 650).

Results

There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9 ± 11 to 2.9 ± 6 days (mean ± standard deviation; P < .001); 2 [1-4] to 1 [0-3] (median [Q1-Q3]); in-hospital length of stay decreased from 13.5 ± 15 to 12.7 ± 11 days (mean ± standard deviation; P = .01); 9 [7-13] to 9 [7-11] (median [Q1-Q3]), in pre-IMCU-CS to post-IMCU-CS, respectively. There were no statistically significant differences in in-hospital mortality (4.9% vs 3.5%; P = .28) or 30-day readmission rate (4.3% vs 4.2%; P = .89).

Conclusions

After the establishment of an IMCU-CS for postoperative cardiac surgery, there was a reduction in ICU and in-hospital mean lengths of stay with no increase in in-hospital mortality or 30-day readmissions.

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1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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