The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
10.5090/kjtcs.2020.53.1.8
- Author:
Dong Jung KIM
1
;
Bongyeon SOHN
;
Hakju KIM
;
Hyoung Woo CHANG
;
Jae Hang LEE
;
Jun Sung KIM
;
Cheong LIM
;
Kay-Hyun PARK
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Publication Type:Clinical Research
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2020;53(1):8-15
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications.
Methods:Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity- matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group).
Results:Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group.
Conclusion:A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.
