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Predictors, prognosis and costs of prolonged intensive care unit stay after surgery for type A aortic dissection
F. Biancari, A. Hérve, S. Peterss, C. Radner, J. Buech, M. Pettinari, J. Rodriguez Lega, AG. Pinto, A. Fiore, F. Onorati, A. Francica, K. Wisniewski, T. Demal, L. Conradi, J. Rocek, P. Kacer, G. Gatti, I. Vendramin, M. Rinaldi, L. Ferrante, R....
Jazyk angličtina Země Itálie
Typ dokumentu časopisecké články, multicentrická studie, práce podpořená grantem
- MeSH
- aortální aneurysma chirurgie ekonomika mortalita MeSH
- délka pobytu * ekonomika MeSH
- disekce aorty * chirurgie ekonomika mortalita MeSH
- jednotky intenzivní péče * ekonomika MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích * MeSH
- prognóza MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated. METHODS: This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU. RESULTS: The mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days). CONCLUSIONS: Prolonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.
Cardiothoracic Department Azienda Sanitaria Universitaria Friuli Centrale Udine Italy
Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France
Department of Cardiac Surgery Glenfield Hospital Leicester UK
Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany
Department of Cardiac Surgery Martin Luther University Halle Wittenberg Halle Germany
Department of Cardiac Surgery Molinette Hospital University of Turin Turin Italy
Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium
Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany
Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany
Department of Cardiovascular Surgery University Hospital Gregorio Marañón Madrid Spain
Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland
Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France
Division of Cardiac Surgery University of Verona Medical School Verona Italy
German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany
Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland
Liverpool Centre for Cardiovascular Sciences Liverpool Heart and Chest Hospital Liverpool UK
Research Unit of Surgery Anesthesia and Critical Care University of Oulu Oulu Finland
Citace poskytuje Crossref.org
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- $a Biancari, Fausto $u Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland - faustobiancari@yahoo.it $u Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland - faustobiancari@yahoo.it
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- $a Predictors, prognosis and costs of prolonged intensive care unit stay after surgery for type A aortic dissection / $c F. Biancari, A. Hérve, S. Peterss, C. Radner, J. Buech, M. Pettinari, J. Rodriguez Lega, AG. Pinto, A. Fiore, F. Onorati, A. Francica, K. Wisniewski, T. Demal, L. Conradi, J. Rocek, P. Kacer, G. Gatti, I. Vendramin, M. Rinaldi, L. Ferrante, R. Pruna-Guillen, E. Quintana, D. DI Perna, G. Mariscalco, M. Jormalainen, M. Field, A. Harky, AM. Dell'aquila, T. Juvonen, T. Mäkikallio, A. Perrotti
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- $a BACKGROUND: The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated. METHODS: This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU. RESULTS: The mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days). CONCLUSIONS: Prolonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.
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