REPORTS OF ORIGINAL INVESTIGATIONS
Long-term survival and resource use in critically ill cardiac
surgery patients: a population-based study
Survie a
`
long terme et utilisation des ressources par les patients
chirurgicaux cardiaques dans un e
´
tat critique : une e
´
tude base
´
e
sur la population
Daniel I. McIsaac, MD, MPH, FRCPC
.
Bernard McDonald, MD, PhD, FRCPC
.
Coralie A. Wong, MSc
.
Carl van Walraven, MD, MSc, FRCPC
Received: 30 October 2017 / Revised: 24 March 2018 / Accepted: 28 March 2018
Ó Canadian Anesthesiologists’ Society 2018
Abstract
Purpose Most cardiac surgery patients recover well; a
substantial minority become critically ill after surgery. The
epidemiology of critical illness after cardiac surgery is
poorly described. We measured the association of
prolonged critical illness with long-term survival and
resource use after cardiac surgery.
Methods This was a historical population-based cohort
study in Ontario, Canada (2002-2013), of adult cardiac
surgery patients. Validated methods were used to measure
postoperative intensive care unit (ICU) length of stay
(LOS). We categorized patients into short (0-2 day),
moderate (3-9 day), and long (10? day) ICU LOS
groups. The adjusted associations of ICU LOS with one-
year survival (primary outcome) and costs, hospital
readmissions, and institutional discharge were measured
using multilevel, multivariable regression. Pre-specified
sensitivity analyses were performed.
Results We included 111,740 patients having their first
cardiac surgery during the study period who survived C
ten postoperative days. Most patients had a short ICU LOS
(75.9%); 20.9% and 3.3% had moderate or long ICU LOS,
respectively. The short-stay one-year mortality rate was
2.1%. Longer ICU LOS was independently associated with
This article is accompanied by an editorial. Please see Can J Anesth
2018; 65: this issue.
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s12630-018-1159-2) contains supple-
mentary material, which is available to authorized users.
D. I. McIsaac, MD, MPH, FRCPC Á B. McDonald, MD, PhD,
FRCPC
Department of Anesthesiology and Pain Medicine, University of
Ottawa, Ottawa, Canada
D. I. McIsaac, MD, MPH, FRCPC
Department of Anesthesiology and Pain Medicine, The Ottawa
Hospital, Ottawa, Canada
D. I. McIsaac, MD, MPH, FRCPC Á C. van Walraven, MD,
MSc, FRCPC
Ottawa Hospital Research Institute, Ottawa, Canada
D. I. McIsaac, MD, MPH, FRCPC Á C. A. Wong, MSc Á
C. van Walraven, MD, MSc, FRCPC
Institute for Clinical Evaluative Sciences, Toronto, Canada
D. I. McIsaac, MD, MPH, FRCPC Á C. van Walraven, MD,
MSc, FRCPC
School of Epidemiology, Public Health and Preventive
Medicine, University of Ottawa, Ottawa, ON, Canada
D. I. McIsaac, MD, MPH, FRCPC (&)
Department of Anesthesiology and Pain Medicine, The Ottawa
Hospital, 1053 Carling Ave, Room B311, Ottawa, ON K1Y 4E9,
Canada
e-mail: dmcisaac@toh.ca
B. McDonald, MD, PhD, FRCPC
Division of Cardiac Anesthesiology, University of Ottawa Heart
Institute, Ottawa, Canada
C. van Walraven, MD, MSc, FRCPC
Department of Medicine, University of Ottawa, The Ottawa
Hospital, Ottawa, Canada
123
Can J Anesth/J Can Anesth
https://doi.org/10.1007/s12630-018-1159-2
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