Improved Long-term Survival in the Patients with Prolonged Intensive Care Unit Stay Stay After Cardiac Surgery: Influence of Quality Improvement program

Background: Prolonged ICU stay after cardiac surgery associated with high mortality and recourse utilization. Quality improvement is an important activity for critical care team and should be decrease mortality. The aim of the study was to evaluate the impact introduction of quality improvement program and intensivist-directed ICU on the long-term outcome of patients with prolonged ICU stay after cardiac surgery.

Method: We performed an observational cohort study with historical controls in an eight-bed Cardiac Surgical ICU in a tertiary university medical center. We studied patients with long, ≥ 7 days, ICU stay. The study period included from January 2004 to June 2014. For analysis we grouped patients into two periods, Group I (first period, 2004-2006), before, and Group II (second period, 2009-2014, after quality improvement interventions implementation. Time period 2007-2008, during which the interventions were taken, was excluded from the analysis.

Results: There were 143 in the Group I and 283 patients in the Group II. There was no significant difference in the mean of the standard (9.3±3.7 vs. 9.7±3.8) and logistic EuroSCORE (20.3±19.2 vs. 22.5±19.4) between the groups. Unadjusted 30-days mortality decreased significantly from 20.3% (29 pat) to 14.5% (41 pat) and 1-year mortality decreased from 42% (60 pat) to 33.9% (91 pat) respectively.

Conclusion: Introducing quality improvement interventions and intensivist-directed ICU model were associated with decreased 30-days and 1-year mortality among very high-risk patients with long ICU stay after cardiac surgery.