Original Article| Volume 36, ISSUE 12, P4313-4319, December 2022

Outcomes of Prolonged ICU Stay for Patients Undergoing Cardiac Surgery in Australia and New Zealand

Published:September 04, 2022DOI:


      To determine the effect of intensive care unit (ICU) length of stay (LOS) on hospital mortality and non-home discharge for patients undergoing cardiac surgery over a 16-year period in Australia and New Zealand.


      A retrospective, multicenter cohort study covering the period January 1, 2004 to December 31, 2019.


      One hundred one hospitals in Australia and New Zealand that submitted data to the Australia New Zealand Intensive Care Society Adult Patient Database.


      Adult patients (aged >18) who underwent coronary artery bypass grafting, valve surgery, or combined valve + coronary artery surgery.



      Measurements and Main Results

      The authors analyzed 252,948 cardiac surgical patients from 101 hospitals, with a median age of 68.3 years (IQR 60-75.5), of whom 74.2% (187,632 of 252,948) were male patients. A U-shaped relationship was observed between ICU LOS and hospital mortality, with significantly elevated mortality at short (<20 hours) and long (>5 days) ICU LOS, which persisted after adjustment for illness severity and across clinically important subgroups (odds ratio for mortality with ICU LOS >5 days = 3.21, 95% CI 2.88-3.58, p < 0.001).


      Prolonged duration of ICU LOS after cardiac surgery is associated with increased hospital mortality in a U-shaped relationship. An ICU LOS >5 days should be considered a meaningful definition for prolonged ICU stay after cardiac surgery.

      Key Words

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        • Stephens RS
        • Whitman GJR.
        Postoperative critical care of the adult cardiac surgical patient. Part I: Routine postoperative care.
        Crit Care Med. 2015; 437: 1477-1497
        • Kapadohos T
        • Angelopoulos E
        • Vasileiadis I
        • et al.
        Determinants of prolonged intensive care unit stay in patients after cardiac surgery: A prospective observational study.
        J Thorac Dis. 2017; 91: 70-79
        • Diab MS
        • Bilkhu R
        • Soppa G
        • et al.
        The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study.
        J Thorac Cardiovasc Surg. 2018; 1565 (e3): 1906-1915
        • Mackie-Savage UF
        • Lathlean J.
        The long-term effects of prolonged intensive care stay postcardiac surgery.
        J Card Surg. 2020; 3511: 3099-3107
        • Diab M
        • Bilkhu R
        • Soppa G
        • et al.
        Quality of life in relation to length of intensive care unit stay after cardiac surgery.
        J Cardiothorac Vasc Surg. 2017; 313: 1080-1090
        • Almashrafi A
        • Alsabti H
        • Mukaddirov M
        • et al.
        Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: A retrospective observational study.
        BMJ Open. 2016; 66e010764
        • Barrie K
        • Cornick A
        • Debreuil S
        • et al.
        Patients with a prolonged intensive care unit length of stay have decreased health-related quality of life after cardiac surgery.
        Semin Thorac Cardiovasc Surg. 2019; 311: 21-31
        • Almashrafi A
        • Elmontsri M
        • Aylin P.
        Systematic review of factors influencing length of stay in ICU after adult cardiac surgery.
        BMC Health Serv Res. 2016; 16: 318
        • Tunç M
        • Şahutoğlu C
        • Karaca N
        • et al.
        Risk factors for prolonged intensive care unit stay after open heart surgery in adults.
        Turk J Anaesthesiol Reanim. 2018; 464: 283-291
        • Patra C
        • Chamaiah Gatti P
        • Panigrahi A
        Morbidity after cardiac surgery under cardiopulmonary bypass and associated factors: A retrospective observational study.
        Indian Heart J. 2019; 714: 350-355
        • Zarrizi M
        • Paryad E
        • Khanghah AG
        • et al.
        Predictors of length of stay in intensive care unit after coronary artery bypass grafting: Development a risk scoring system.
        Braz J Cardiovasc Surg. 2021; 361: 57-63
        • Zhang X
        • Zhang W
        • Lou H
        • et al.
        Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: A retrospective observational study.
        Int J Nurs Sci. 2021; 84: 388-393
        • Kao KD
        • Lee SKC
        • Liu CY
        • et al.
        Risk factors associated with longer stays in cardiovascular surgical intensive care unit after CABG.
        J Formos Med Assoc. 2022; 1211: 304-313
        • Hein OV
        • Birnbaum J
        • Wernecke K
        • et al.
        Prolonged intensive care unit stay in cardiac surgery: Risk factors and long-term-survival.
        Ann Thorac Surg. 2006; 813: 880-885
        • Hassan A
        • Anderson C
        • Kypson A
        • et al.
        Clinical outcomes in patients with prolonged intensive care unit length of stay after cardiac surgical procedures.
        Ann Thorac Surg. 2012; 932: 565-569
        • Mahesh B
        • Choong CK
        • Goldsmith K
        • et al.
        Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations.
        Ann Thorac Surg. 2012; 941: 109-116
        • Yu PJ
        • Cassiere HA
        • Fishbein J
        • et al.
        Outcomes of patients with prolonged intensive care unit length of stay after cardiac surgery.
        J Cardiothorac Vasc Anesth. 2016; 306: 1550-1554
        • McIsaac DI
        • McDonald B
        • Wong CA
        • et al.
        Long-term survival and resource use in critically ill cardiac surgery patients: A population-based study.
        Can J Anaesth. 2018; 659: 985-995
        • Trivedi V
        • Bleeker H
        • Kantor N
        • et al.
        Survival, quality of life, and functional status following prolonged ICU stay in cardiac surgical patients: A systematic review.
        Crit Care Med. 2019; 471: e52-e63
        • Silberman S
        • Bitran D
        • Fink D
        • et al.
        Very prolonged stay in the intensive care unit after cardiac operations: Early results and late survival.
        Ann Thorac Surg. 2013; 961 (discussion 21-2): 15-21
        • Ramanan M
        • Kumar A
        • Anstey C
        • et al.
        Non-home discharge after cardiac surgery in Australia and New Zealand: A cross-sectional study.
        BMJ Open. 2021; 1112e049187
        • Mori M
        • Mahmood SUB
        • Zhuo H
        • et al.
        Persistence of risk of death after hospital discharge to locations other than home after cardiac surgery.
        J Thorac Cardiovasc Surg. 2020; 1592 (e1): 528-535
        • Edgerton JR
        • Herbert MA
        • Mahoney C
        • et al.
        Long-term fate of patients discharged to extended care facilities after cardiovascular surgery.
        Ann Thorac Surg. 2013; 963: 871-877
        • Henry L
        • Halpin L
        • Hunt S
        • et al.
        Patient disposition and long-term outcomes after valve surgery in octogenarians.
        Ann Thorac Surg. 2012; 943: 744-750
      1. Australia and New Zealand Intensive Care Society. Centre for Outcome and Resource Evaluation 2020 Report. Available at: Accessed May 11, 2022.

        • Nashef SAM
        • Roques F
        • Sharples LD
        • et al.
        EuroSCORE II.
        Eur J Cardiothorac Surg. 2012; 414 (discussion 744-5): 734-745