Abstract

 Critical care services are one of the most demanding specialties in clinical practice and readmission to the intensive care unit has substantial financial and resource implications. Readmission and use of an expensive intensive care bed may be for a preventable complication. The aim of this study is to determine the readmission rate in the intensive care unit at the National Cardiothoracic Center, the causes of readmission, the mortality rate and to identify high risk patients who may need readmission. This was retrospective study which included patients admitted in the intensive care unit between 1st January 2001 to December 31st 2004. The records of all the cases readmitted were retrieved and information regarding the cause of readmission, management and outcome of management were recorded. Six hundred and three patients were admitted over the four year period at the Cardiothoracic intensive care unit (ICU) and there were eighteen readmissions. The readmission rate was 3.1%. The average length of stay of patients admitted in the ICU was 2.05 days and the average lenght of stay of readmitted patients was 3.9 days. The mortality patients admitted at the ICU was 2.3% and the mortality of readmitted patients was 27.8%. Congestive cardiac failure and chest infection after open heart surgery from 22.2% and 16.7% respectively and anastomic leakage after oesophagogastrosomy accounted for 27.8% of the readmissions. Other causes of ICU  readmittions were infection of sternotomy (16.7%), dislodged electrode after permanent pacemaker implantation (11.1%) and a case of residual ventricular septal defect (5.5%). The study shows that readmission of cardiac and thoracic surgical patients to the ICU are low but are associted with a high morbidity and mortality. The average lenght of stay of readmitted patients in the ICU was about twice the admitted patients. Ederly patients who has oesophagectomy and intrathoracic oesophagogastrostomy are at a greatest risk of readmission and congestive cardiac failure is the major reason for ICU readmission after cardiac surgery.