Ten days or more in the ICU after cardiac surgery tied to high risk of death and healthcare costs

In Ontario, people who have had cardiac surgery and then stay in the intensive care unit (ICU) for 10 days or longer were 8.5 times more likely to die in the year after surgery, even after adjusting for baseline illness and type of surgery, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES).

The study published in the Canadian Journal of Anaesthesia found of the 111,740 people having cardiac surgery in Ontario from 2002 to 2013, 3,666 stayed in ICU at least 10 days after surgery. Of the 3,666 who stayed in the ICU for at least 10 days, 1,217 died in the year after surgery.

“The majority of cardiac surgery patients in Ontario go to the ICU after surgery. For most, this is an expected step in recovery, and they will move through the ICU quickly, usually two days or less. However, for some people who were sicker before surgery, had more invasive surgery, or who developed organ failure during or immediately after surgery, longer ICU stays may be required,” says Dr. Daniel McIsaac, lead author on the study, adjunct scientist at ICES and anesthesiologist at The Ottawa Hospital.

The study showed that 55 per cent of patients who had cardiac surgery and then stayed in the ICU for at least 10 days after surgery, were either discharged to a nursing home or died while still in hospital.

The researchers found that not only were cardiac surgery patients requiring ICU care for 10 days or more at a higher mortality risk the year after surgery, they occupied more than 30 per cent of bed days despite representing only five per cent of ICU patients.

The researchers also found that people who required a long ICU stay after surgery had significantly higher healthcare costs, which amounted to $100,000 more than people who were able to leave the ICU within two days of surgery.

“On average, a patient who had cardiac surgery and stayed two days or less in the ICU had health system costs of $29,000 but a long stay patient had health system costs of $120, 000. Both of these scenarios included subsequent surgery up to one year after the initial procedure,” adds McIsaac.

Author block: Daniel I McIsaac, Bernard McDonald, Coralie A Wong and Carl van Walraven.

The article “Longterm survival and resource use in critically ill cardiac surgery patients: a population-based study” is published in the Canadian Journal of Anaesthesia.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

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