A closed surgical intensive care unit organization improves cardiac surgical patient outcomes.

Autor:	Johnson LA; Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Klucher B; Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Jensen H; Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Reif R; Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.; Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Kalkwarf KJ; Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Sexton K; Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.; Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.; Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.; Division of Pharmaceutical Evaluation and Policy (PEP), Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Kimbrough MK; Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2024 Feb 29; Vol. 16 (2), pp. 1262-1269. Date of Electronic Publication: 2024 Feb 27.
DOI:	10.21037/jtd-22-1471
Abstrakt:	Background: Intensive care unit (ICU) organization is a critical factor in optimizing patient outcomes. ICU organization can be divided into "OPEN" (O) and "CLOSED" (C) models, where the specialist or intensivist, respectively, assumes the role of primary physician. Recent studies support improved outcomes in closed ICUs, however, most of the available data is centered on ICUs generally or on subspecialty surgical patients in the setting of a subspecialized surgical intensive care unit (SICU). We examined the impact of closing a general SICU on patient outcomes following cardiac and ascending aortic surgery. Methods: A retrospective cohort of patients following cardiac or ascending aortic surgery by median sternotomy was examined at a single academic medical center one year prior and one year after implementation of a closed SICU model. Patients were divided into "OPEN" (O; n=53) and "CLOSED" (C; n=73) cohorts. Results: Cohorts were comparable in terms of age, race, and number of comorbid conditions. A significant difference in male gender (O: 60.4% vs. C: 76.7%, P=0.049), multiple procedure performed (O: 13.21% vs. C: 35.62%, P=0.019), and hospital readmission rates was detected (O: 39.6% vs. C: 9.6%, P=0.0003). Using a linear regression model, a closed model SICU organization decreased SICU length of stay (LOS). Using a multivariate logistic regression, being treated in a closed ICU decreased a patient's likelihood of having an ICU LOS greater than 48 hours. Conclusions: Our study identified a decreased ICU LOS and hospital readmission in cardiac and ascending aortic patients in a closed general SICU despite increased procedure complexity. Further study is needed to clarify the effects on surgical complications and hospital charges. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1471/coif). K.K. reports academic grants from the UAMS Translational Research Institute, and is a Trauma Medical Consultant for the Arkansas Trauma System, Site Designation Verifier for the Arkansas Trauma System, Qsource consultant for the Arkansas Preventable Mortality Committee, and ATLS instructor for the Arkansas Trauma Society. K.S. reports academic grants from the NIH, consulting fees from Datafy, LLC, and stock options for Decision Healthcare INC and Hoopcare Inc. The other authors have no conflicts of interest to declare. (2024 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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