Persistent critical illness and long-term survival in cardiac surgery: A multicentre cohort study - 18/09/25

Doi : 10.1016/j.accpm.2025.101593

Ashwin Subramaniam ^a,^b,^c,^d,^⁎ , Ryan Ruiyang Ling ^d,^e,^f, William Bonavia ^g, Kollengode Ramanathan ^e,^h, Mahesh Ramanan ^i,^j,^k,^l,^m, Kiran Shekar ^j,^k,^l,ⁿ, David Pilcher ^d,^g,^o

^a Department of Intensive Care Medicine, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia

^b Peninsula Clinical School, Monash University, Frankston, Victoria, Australia

^c Department of Intensive Care Medicine, Epworth Healthcare, Richmond, Victoria, Australia

^d Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

^e Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore

^f Department of Anaesthesia, National University Hospital, National University Health System, Singapore

^g Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia

^h Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore

ⁱ Intensive Care Unit, Caboolture Hospital, Brisbane, Queensland, Australia

^j Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia

^k Bond University, Gold Coast, Queensland, Australia

^l Mayne Academy of Critical Care, School of Medicine, The University of Queensland, St Lucia, Queensland, Australia

^m Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia

ⁿ Queensland University of Technology, Brisbane; University of Queensland, Brisbane, Queensland, Australia

^o Australia Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Victoria, Australia

^⁎ Corresponding author.

Abstract

Background

Persistent critical illness (PerCI) is associated with poorer in-hospital outcomes in patients admitted to an intensive care unit (ICU), and in patients receiving cardiac surgery, yet its association with longer-term survival remains unclear.

Objective

We investigated the association between PerCI and long-term survival in patients receiving cardiac surgery.

Methods

In this retrospective, multicentre observational cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database, we included all adults (≥16 years) admitted to 83 ICUs across Australia and New Zealand after cardiac surgery (coronary artery bypass graft, valvular replacement, or both) from January 1 ^st 2018 to December 31 ^st 2022 for Australia and 31 ^st December 2020 for New Zealand. The primary outcome was survival time up to 4 years after ICU admission. We analysed the association between PerCI (defined as ICU length of stay ≥6 days) and survival time up to 4 years from ICU admission using a Cox proportional hazards model.

Results

We included 73,462 patients (90.8% elective, 9.2% emergent), of whom 5,087 (6.9%) developed PerCI. PerCI was associated with shorter survival times (hazard ratio [HR]: 3.14, 95%-CI: 2.77–3.55). As ICU stays became progressively longer, survival times progressively decreased (HR by additional day in ICU: 1.02, 95%-CI: 1.01–1.03). PerCI was associated with larger reductions in survival times in patients aged <65 years (HR: 5.61, 95%-CI: 4.72–6.67) compared to patients ≥65 years (HR: 2.83, 95%-CI: 2.48–3.23, p-interaction <0.0001). However, there were no significant differences amongst the various types of surgeries, and between elective and emergent surgeries.

Conclusion

PerCI was associated with poorer outcomes, and this persisted during longer-term follow-up. Further study is required to identify potential modifiable risk factors for PerCI.

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Abbreviations : PerCI, ICU, HR, CI, APACHE, ANZICS, STROBE, APD, SOFA, ANZROD, CFS, IQR, ECMO, ERAS, CABG

Keywords : Cardiac surgery, Long-term outcome, Persistent critical illness, Length of stay

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Vol 44 - N° 6

Article 101593- novembre 2025 Retour au numéro

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Persistent critical illness and long-term survival in cardiac surgery: A multicentre cohort study - 18/09/25

Abstract

Background

Objective

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Conclusion

Plan

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