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Brazilian Journal of Clinical Medicine and Review

Special Issue: Health Research in Sub-Saharan Africa

Vol. 4 No. 1 (2026): January/December - 2026

Factors Associated with Prolonged ICU Stay in the Postoperative Period of Cardiac Surgery in a Reference Hospital in Angola

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2026.4.1.bjcmr48
Submitted
August 14, 2025
Published
2025-11-25

Abstract

Cardiac surgery is a complex procedure, and the number of patients with high surgical risk has increased due to the rise in elderly patients with a greater number of comorbidities. Several risk factors influence the length of stay in the intensive care unit (ICU). This study aimed to evaluate risk factors associated with prolonged ICU stay in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A retrospective study was conducted from January to December 2024 with adult patients undergoing surgery with CPB. Data related to pre-, intra-, and postoperative variables were collected. Prolonged ICU stay exceeding four days was considered. Among the 47 patients included, the median age was 47 years; 26 (55.3%) were male. Valvular surgery was the most frequent procedure (66%). Nine (19.2%) presented with prolonged ICU stay. The median age was higher in the TIP group (33.06 years vs. 21.86; p=0.027). There was a positive correlation between TIP and mechanical ventilation (r=0.30; p=0.04), intubation time (r=0.30; p=0.04), neutrophil/lymphocyte ratio (r=0.30; p=0.01), and a negative correlation with the absolute lymphocyte count (r=-0.39; p=0.005). Pre- and postoperative variables, including age, mechanical ventilation, intubation time, INL, and lymphocyte count, were associated with TIP in the ICU.

References

  1. Bojar RM. Manual of perioperative care in adult cardiac surgery. Hoboken: John Wiley & Sons; 2020.
  2. Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: Access to cardiac surgical care around the world. J Thorac Cardiovasc Surg. 2020 Mar;159(3):987-996.e6. doi:10.1016/j.jtcvs.2019.04.039.
  3. Yaffee DW, Williams MR. Cardiovascular surgery in the elderly. Semin Thorac Cardiovasc Surg. 2016 Winter;28(4):741-7. doi:10.1053/j.semtcvs.2016.08.007.
  4. Pezzella AT. Global aspects of cardiothoracic surgery with focus on developing countries. Asian Cardiovasc Thorac Ann. 2010 Jun;18(3):299-310. doi:10.1177/0218492310370060.
  5. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015 Aug 8;386(9993):569-624.
  6. Dong MF, Ma ZS, Wang JT, Chai SD, Tang PZ, Wang LX. Impact of peripherally established cardiopulmonary bypass on regional and systemic blood lactate levels. Heart Lung Circ. 2012 Mar;21(3):154-8. doi:10.1016/j.hlc.2011.10.014.
  7. Aljure OD, Fabbro M 2nd. Cardiopulmonary bypass and inflammation: the hidden enemy. J Cardiothorac Vasc Anesth. 2019 Feb;33(2):346-7. doi:10.1053/j.jvca.2018.05.030.
  8. Fonseca L, Vieira FN, Azzolin KO. Fatores associados ao tempo de ventilação mecânica no pós-operatório de cirurgia cardíaca. Rev Gaúcha Enferm. 2014;35:67-72.
  9. Leballo G, Moutlana HJ, Muteba MK, Chakane PM. Factors associated with acute kidney injury and mortality during cardiac surgery. Cardiovasc J Afr. 2021;32(6):308-13. doi:10.5830/CVJA-2020-063.
  10. Veronese N, Custodero C, Cella A, Demurtas J, Zora S, Maggi S, et al. Prevalence of multidimensional frailty and pre-frailty in older people in different settings: a systematic review and meta-analysis. Ageing Res Rev. 2021 Dec;72:101498. doi:10.1016/j.arr.2021.101498.
  11. Clough RA, Leavitt BJ, Morton JR, Plume SK, Hernandez F, Nugent W, et al. The effect of comorbid illness on mortality outcomes in cardiac surgery. Arch Surg. 2002 Apr;137(4):428-32. doi:10.1001/archsurg.137.4.428.
  12. Azarfarin R, Ashouri N, Totonchi Z, Bakhshandeh H, Yaghoubi A. Factors influencing prolonged ICU stay after open heart surgery. Res Cardiovasc Med. 2014;3(4):e20159. doi:10.5812/cardiovascmed.20159.
  13. Rosenfeld R, Smith JM, Woods SE, Engel AM. Predictors and outcomes of extended intensive care unit length of stay in patients undergoing coronary artery bypass graft surgery. J Card Surg. 2006;21(2):146-50. doi:10.1111/j.1540-8191.2006.00196.x.
  14. Widyastuti Y, Stenseth R, Wahba A, Pleym H, Videm V. Length of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model? Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):825-32. doi:10.1093/icvts/ivs302.
  15. De Cocker J, Messaoudi N, Stockman BA, Bossaert LL, Rodrigus IE. Preoperative prediction of intensive care unit stay fol-lowing cardiac surgery. Eur J Cardiothorac Surg. 2011;39(1):60-7. doi:10.1016/j.ejcts.2010.04.015.
  16. Almashrafi A, Alsabti H, Mukaddirov M, Balan B, Aylin P. Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study. BMJ Open. 2016 Jun 8;6(6):e010764. doi:10.1136/bmjopen-2015-010764.
  17. Varma PK, Kundan S, Ananthanarayanan C, et al. Demographic profile, clinical characteristics and outcomes of patients undergoing coronary artery bypass grafting: retrospective analysis of 4,024 patients. Indian J Thorac Cardiovasc Surg. 2014;30:272-7. doi:10.1007/s12055-014-0318-5.
  18. Habib AM, Hussain A, Jarvis M, Cowen ME, Chaudhry MA, Loubani M, et al. Changing clinical profiles and in-hospital outcomes of octogenarians undergoing cardiac surgery over 18 years: a single-centre experience. Interact Cardiovasc Thorac Surg. 2019 Apr;28(4):602-6. doi:10.1093/icvts/ivy293.
  19. Mahesh B, Choong CK, Goldsmith K, Gerrard C, Nashef SA, Vuylsteke A. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg. 2012 Jul;94(1):109-16.
  20. Atalan N, Fazlioğulları O, Kunt AT, Başaran C, Gürer O, Şitilci T, et al. Effect of body mass index on early morbidity and mortality after isolated coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2012;26(5):813-7.
  21. Zhang X, Wu Z, Peng X, Wu A, Yue Y, Martin J, Cheng D. Prognosis of diabetic patients undergoing coronary artery bypass surgery compared with nondiabetics: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2011;25(2):288-98. doi:10.1053/j.jvca.2010.09.021.
  22. Guangqing Z, Liwei C, Fei L, Jianshe Z, Guang Z, Yan Z, et al. Predictive value of neutrophil to lymphocyte ratio on acute kidney injury after on-pump coronary artery bypass: a retrospective, single-center study. Gen Thorac Cardiovasc Surg. 2022 Jul;70(7):624-33. doi:10.1007/s11748-022-01772-z.
  23. Güntürk İ, Ozmen R, Ozocak O, Güntürk EE, Dagli F, Yazici C. The systemic immune-inflammation index predicts in-hospital mortality in patients who underwent on-pump cardiac surgery. Arq Bras Cardiol. 2024;121(4):e20230245.
  24. Parmana IMA, Boom CE, Poernomo H, Gani C, Nugroho B, Cintyandy R, et al. Systemic immune-inflammation index predicts prolonged mechanical ventilation and intensive care unit stay after off-pump coronary artery bypass graft surgery: a sin-gle-center retrospective study. Vasc Health Risk Manag. 2023;19:353-61. doi:10.2147/VHRM.S409678.
  25. Perry LA, Liu Z, Loth J, Penny-Dimri JC, Plummer M, Segal R, Smith J. Perioperative neutrophil–lymphocyte ratio predicts mortality after cardiac surgery: systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2022;36(5):1296-303.
  26. Haran C, Gimpel D, Clark H, McCormack DJ. Preoperative neutrophil and lymphocyte ratio as a predictor of mortality and morbidity after cardiac surgery. Heart Lung Circ. 2021;30(3):414-8. doi:10.1016/j.hlc.2020.05.115.
  27. Aghdaii N, Ferasatkish R, Mohammadzadeh Jouryabi A, Hamidi SH. Significance of preoperative total lymphocyte count as a prognostic criterion in adult cardiac surgery. Anesth Pain Med. 2014;4(3):e20331. doi:10.5812/aapm.20331.
  28. Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, Sisillo E. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22(6):814-22.
  29. Torrati FG, Dantas RAS. Circulação extracorpórea e complicações no período pós-operatório imediato de cirurgias cardíacas. Acta Paul Enferm. 2012;25:340-5.
  30. Vervoort D, Swain JD, Pezzella AT, Kpodonu J. Cardiac surgery in low- and middle-income countries: a state-of-the-art review. Ann Thorac Surg. 2021;111(4):1394-400. doi:10.1016/j.athoracsur.2020.05.181.
  31. Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001;120(4):1262-70. doi:10.1378/chest.120.4.1262.
  32. Krishnan JA, Moore D, Robeson C, Rand CS, Fessler HE. A prospective, controlled trial of a protocol-based strategy to dis-continue mechanical ventilation. Am J Respir Crit Care Med. 2004;169(6):673-8. doi:10.1164/rccm.200306-761OC.
  33. Navalesi P, Frigerio P, Moretti MP, Sommariva M, Vesconi S, Baiardi P, Levati A. Rate of reintubation in mechanically ven-tilated neurosurgical and neurologic patients: evaluation of a systematic approach to weaning and extubation. Crit Care Med. 2008;36(11):2986-92. doi:10.1097/CCM.0b013e31818b35f2.
  34. Lin YC, Chang RL, Tang CC. Safety and efficacy of nurse-led weaning protocols on ICU patients: a systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs. 2025;22(2):e70015. doi:10.1111/wvn.70015.

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