The Impact of Initiation of an Intensivist-Led Patient Management Protocol on Outcomes After Cardiac Surgery.
OBJECTIVES
Prolonged intensive care unit stay after cardiac surgery is associated with high mortality. The aim of this study was to evaluate the impact of the introduction of a quality improvement program under the supervision of an intensivist on the long-term mortality of high-risk patients with prolonged intensive care unit (ICU) stay after cardiac surgery.


DESIGN
Retrospective study of prospectively collected data.


SETTING
Cardiac surgery ICU.


PARTICIPANTS
A total of 7,549 patients after cardiac surgery.


INTERVENTIONS
Patients were divided into two periods: 2004 to 2007, before introducing the quality improvement program (3,315 patients), and 2009 to 2014, after introduction of the program (4,234 patients). In the period from 2004 to 2007, patients were divided into group I (ICU stay ≥ seven days), which included 242 patients, and group III (ICU stay < seven days), which included 3,073 patients. Also, in the period from 2009 to 2014 patients, were divided into group II (ICU stay ≥seven days), which included 326 patients, and group IV (ICU stay < seven days), which included 3,908 patients. Patient outcomes were compared. Follow-up was five years for each group.


MEASUREMENTS AND MAIN RESULTS
The European System for Cardiac Operative Risk Evaluation did not differ significantly among the groups. When comparing between group I and group II, 30-day mortality decreased significantly from 24.8% to 16.6%, six-month mortality from 27.3% to 19.3%, one-year mortality from 42.1% to 32.2%, 3-year mortality from 54.5% to 43.3%, and 5-year mortality from 61.2% to 51.8%. In comparing between group III and group IV, the authors did not observe a statistically significant decrease of mortality.


CONCLUSIONS
Intensivist-led patient management protocol is associated with decreased long-term mortality in high-risk patients with a prolonged ICU stay.
['Kogan|Alexander|A|', 'Kassif|Yigal|Y|', 'Frogel|Jonathan|J|', 'Levin|Shany|S|', 'Ram|Eilon|E|', 'Peled|Yael|Y|', 'Raanani|Ehud|E|', 'Sternik|Leonid|L|']
D006348:Cardiac Surgical Procedures D003422:Critical Care D017052:Hospital Mortality D006801:Humans D007362:Intensive Care Units D007902:Length of Stay D012189:Retrospective Studies
quality improvement cardiac surgery intensive care unit postoperative care