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12
Giornale Italiano di Cardiologia Pratica
It J Practice Cardiol
Ottobre 2003
Tab. 9
Thresholds and
preponderance of stays
in intensive and
postoperative lenght of stay.
Tab. 10
Destiny of long staying
patients in intensive care.
(a = personal case history).
The proportion of patients who have a prolonged
course in ICU is around 5.7-10%,
whereas the proportion of patients with prolonged
hospital course ranges from 8% to
37%. This gap is not only due to the severity
of operated patients’ conditions or to the
experience of individual surgeons. It can also
be due to the cut-off used to define “pro-
longed stay” (from 3 to 10 days in ICU and
from 7 to 14 days in a postoperative course,
according to single studies) [Table 9].
Nevertheless, the distribution of the ICU and hospital
LOS and hospital is very similar in different
studies and is highly skewed, characterised by a
shift of the mean and median to lower values
and by a long tail of less frequent values.
AUTHORS INTENSIVE CARE POSTOPERATIVE CARE
Threshold % of patients Threshold % of patients
Mounsey (14) > 3 days 10
Staat (18) > 7 days 5.7
Tu (16) > 10 days 6.2
Bashour (17) > 10 days 5.4
Pinna Pintor (18) > 5 days 6.1 > 10 days 20
Lazar (19) > 7 days 37
UK (13) > 10 days 22
Weintraub (20) > 10 days 15.2
Kurky (21) > 12 days 23
Lahey (22) > 13 days 10
Ferraris (23) > 14 days 8
Stricker (24A) >7 days 10.6
Hughes M (25 A) >30 days 1.6
Destiny of patients with a
prolonged ICU-LOS
In some studies, patients forced into a prolonged
ICU-LOS and hospital were evaluated
to determine their destiny in terms of
mortality, quality of life and resources consumption.
The survival and quality of life of patients
with a prolonged hospitalisation in ICU are
particularly low [Table 10].
STAY THRESHOLD % of patients HOSPITAL MORTALITY IN
IN INTENSIVE MORTALITY FOLLOW UP
CARE % of patients % of patients
Ryan (27) > 14 days 3.8 42 -
Bashour (17)
< 10 days
> 10 days
94.6
5.4
1.5
33.1
-
34 at 12 months
Holmes (28) > 48 h 7.2 33.3 9.3 at 12 months
< 48 h 78.7 0.8
Pinna Pintor (18)
> 48 h
>5 days
21.3
6.1
12.5
36.6
1.6 at 3 months
25.3 at 3 months
>10 days 3.3 50
Stricker (24)
< 7 days
> 7 days
89.4
10.6
9.8
19.9
≥ 30 days 40.1
Hughes (25) ≥ 60 days 42.4
≥90 days 44.4
In Ryan’s study (26) (1997), hospital mortality
is 42% for patients (3.8% of the whole popu-
lation) who remained in ICU for more than 14
days. In Bashour’s study (17) (2000), the ho-