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Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery

BACKGROUND: Across the globe, elective surgeries have been postponed to limit infectious exposure and preserve hospital capacity for coronavirus disease 2019 (COVID‐19). However, the ramp down in cardiac surgery volumes may result in unintended harm to patients who are at high risk of mortality if t...

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Autores principales: Sun, Louise Y., Bader Eddeen, Anan, Ruel, Marc, MacPhee, Erika, Mesana, Thierry G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763427/
https://www.ncbi.nlm.nih.gov/pubmed/32990156
http://dx.doi.org/10.1161/JAHA.120.017847
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author Sun, Louise Y.
Bader Eddeen, Anan
Ruel, Marc
MacPhee, Erika
Mesana, Thierry G.
author_facet Sun, Louise Y.
Bader Eddeen, Anan
Ruel, Marc
MacPhee, Erika
Mesana, Thierry G.
author_sort Sun, Louise Y.
collection PubMed
description BACKGROUND: Across the globe, elective surgeries have been postponed to limit infectious exposure and preserve hospital capacity for coronavirus disease 2019 (COVID‐19). However, the ramp down in cardiac surgery volumes may result in unintended harm to patients who are at high risk of mortality if their conditions are left untreated. To help optimize triage decisions, we derived and ambispectively validated a clinical score to predict intensive care unit length of stay after cardiac surgery. METHODS AND RESULTS: Following ethics approval, we derived and performed multicenter valida tion of clinical models to predict the likelihood of short (≤2 days) and prolonged intensive care unit length of stay (≥7 days) in patients aged ≥18 years, who underwent coronary artery bypass grafting and/or aortic, mitral, and tricuspid value surgery in Ontario, Canada. Multivariable logistic regression with backward variable selection was used, along with clinical judgment, in the modeling process. For the model that predicted short intensive care unit stay, the c‐statistic was 0.78 in the derivation cohort and 0.71 in the validation cohort. For the model that predicted prolonged stay, c‐statistic was 0.85 in the derivation and 0.78 in the validation cohort. The models, together termed the CardiOttawa LOS Score, demonstrated a high degree of accuracy during prospective testing. CONCLUSIONS: Clinical judgment alone has been shown to be inaccurate in predicting postoperative intensive care unit length of stay. The CardiOttawa LOS Score performed well in prospective validation and will complement the clinician's gestalt in making more efficient resource allocation during the COVID‐19 period and beyond.
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spelling pubmed-77634272020-12-28 Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery Sun, Louise Y. Bader Eddeen, Anan Ruel, Marc MacPhee, Erika Mesana, Thierry G. J Am Heart Assoc Original Research BACKGROUND: Across the globe, elective surgeries have been postponed to limit infectious exposure and preserve hospital capacity for coronavirus disease 2019 (COVID‐19). However, the ramp down in cardiac surgery volumes may result in unintended harm to patients who are at high risk of mortality if their conditions are left untreated. To help optimize triage decisions, we derived and ambispectively validated a clinical score to predict intensive care unit length of stay after cardiac surgery. METHODS AND RESULTS: Following ethics approval, we derived and performed multicenter valida tion of clinical models to predict the likelihood of short (≤2 days) and prolonged intensive care unit length of stay (≥7 days) in patients aged ≥18 years, who underwent coronary artery bypass grafting and/or aortic, mitral, and tricuspid value surgery in Ontario, Canada. Multivariable logistic regression with backward variable selection was used, along with clinical judgment, in the modeling process. For the model that predicted short intensive care unit stay, the c‐statistic was 0.78 in the derivation cohort and 0.71 in the validation cohort. For the model that predicted prolonged stay, c‐statistic was 0.85 in the derivation and 0.78 in the validation cohort. The models, together termed the CardiOttawa LOS Score, demonstrated a high degree of accuracy during prospective testing. CONCLUSIONS: Clinical judgment alone has been shown to be inaccurate in predicting postoperative intensive care unit length of stay. The CardiOttawa LOS Score performed well in prospective validation and will complement the clinician's gestalt in making more efficient resource allocation during the COVID‐19 period and beyond. John Wiley and Sons Inc. 2020-10-21 /pmc/articles/PMC7763427/ /pubmed/32990156 http://dx.doi.org/10.1161/JAHA.120.017847 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Sun, Louise Y.
Bader Eddeen, Anan
Ruel, Marc
MacPhee, Erika
Mesana, Thierry G.
Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery
title Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery
title_full Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery
title_fullStr Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery
title_full_unstemmed Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery
title_short Derivation and Validation of a Clinical Model to Predict Intensive Care Unit Length of Stay After Cardiac Surgery
title_sort derivation and validation of a clinical model to predict intensive care unit length of stay after cardiac surgery
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763427/
https://www.ncbi.nlm.nih.gov/pubmed/32990156
http://dx.doi.org/10.1161/JAHA.120.017847
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