Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

Am J Med Qual. 2018 Nov/Dec;33(6):576-582. doi: 10.1177/1062860618766614. Epub 2018 Mar 29.

Abstract

This study examined the impact of integrated intensivist consultation in the immediate postoperative period on outcomes for cardiac surgery patients. A retrospective cohort study was conducted in 1711 adult cardiac surgery patients from a single quaternary care center in Minnesota. Outcomes were compared across 2 consecutive 2-year time periods reflecting an elective intensivist model (n = 801) and an integrated intensivist model (n = 910). Patients under the 2 models were comparable with respect to demographics, comorbidities, procedure types, and Society for Thoracic Surgery predicted risk of mortality score; however, patients in the earlier cohort were slightly older and more likely to have chronic kidney disease ( P = .003). Integrated intensivist involvement was associated with reduced postoperative ventilator time, length of stay (LOS), stroke, encephalopathy, and reoperations for bleeding (all P < .01) but was not associated with mortality. Intensivist integration into the postoperative care of cardiac surgery patients may reduce ventilator time, LOS, and complications but may not improve survival.

Keywords: cardiac surgery; critical care; outcome; physician staffing model; postoperative care.

MeSH terms

  • Aged
  • Critical Care*
  • Female
  • Humans
  • Male
  • Medical Staff, Hospital
  • Middle Aged
  • Minnesota
  • Referral and Consultation*
  • Registries
  • Retrospective Studies
  • Thoracic Surgery*