Assessment of Post-Operative Risk Factors for Prolonged ICU Stay 48hrs -72hrs, after Valvular Surgeries
Keywords:
Valvular Surgery, Prolonged ICU Stay, Pulmonary Hypertension, PaO₂/FiO₂ Ratio, Mechanical Ventilation, Acute Kidney Injury, Low Cardiac Output Syndrome.Abstract
Background: Valvular heart disease is a major contributor to cardiovascular morbidity, particularly in low- and middle-income countries where late presentation and rheumatic etiology are common. Patients undergoing valve surgery often experience complex postoperative courses due to preexisting pulmonary hypertension, ventricular dysfunction, and arrhythmias, leading to prolonged intensive care unit (ICU) stay. Extended ICU duration increases the risk of complications, healthcare costs, and resource burden, especially in resource-limited settings like Pakistan.
Objective(s): To assess postoperative hemodynamic, respiratory, and clinical risk factors associated with prolonged ICU stay (≥48 hours) in patients undergoing valvular heart surgeries.
Methodology: A cross-sectional study was conducted on 70 patients undergoing isolated valvular surgery at a tertiary care hospital. Consecutive non-probability sampling was used. Data were collected prospectively at ICU admission and during the first 48–72 postoperative hours, including variables such as mean pulmonary artery pressure (MPAP), PaO₂/FiO₂ ratio, temperature, ventilation duration, and postoperative complications. Statistical analysis was performed using SPSS version 27. Group comparisons were conducted using Chi-square, independent t-test, and Mann–Whitney U test. Logistic regression analysis was applied to identify significant predictors of prolonged ICU stay.
Results: Out of 70 patients, a significant proportion experienced prolonged ICU stay (≥48 hours). Elevated MPAP (≥21 mmHg), impaired oxygenation (PaO₂/FiO₂ ≤300), prolonged mechanical ventilation, hypothermia, low cardiac output syndrome, and acute kidney injury were significantly associated with extended ICU stay. Prolonged ventilation showed the strongest association (OR = 8.2), followed by low cardiac output syndrome and impaired oxygenation. Double-valve surgery and postoperative atrial fibrillation were also significant predictors.
Conclusion: Prolonged ICU stay after valvular surgery is primarily influenced by early postoperative complications and hemodynamic instability. Key predictors include impaired oxygenation, elevated pulmonary artery pressure, hypothermia, prolonged ventilation, and organ dysfunction. Early identification and management of these factors can improve patient outcomes and optimize ICU resource utilization.
