Predictive Factors for a Prolonged Stay in the Surgical Intensive Care Unit

Abstract

The intensive care unit (ICU) is a place of acute care, where patients' vital prognosis, substitution techniques, and family anxiety are intertwined. A prolonged ICU stay often has a negative connotation, raising numerous questions about patient management, functional prognosis, and the appropriateness of continuing intensive care. This study aims to better understand the characteristics and outcomes of patients with prolonged ICU stays and to identify specific management needs. A retrospective analytical study was conducted in the anesthesia and surgical intensive care department of the Ibn Rochd University Hospital in Casablanca from January 2015 to December 2017. The study included 184 patients aged ≥18 years with ICU stays ≥10 days. Data were collected from admission registers and medical records and analyzed using statistical tests to assess factors influencing prolonged ICU stay. From January 2015 to December 2017, 2291 patients were admitted to the ICU at CHU Ibn Rochd. Of these, 184 (8.03%) had extended stays, with an average age of 49.2 years and a predominance of males (55%). The main comorbidities were diabetes (30%) and hypertension (26%). Most patients were admitted via the emergency department (27%) for scheduled (48%) and emergency (19%) surgical conditions. On admission, 40% had a Glasgow score of 13-15, 89% were afebrile, 83% had a normal respiratory rate, and 91% had oxygen saturation >95%. Mechanical ventilation was required for 80% of patients. The main reasons for admission were neurological distress (35%) and post-operative management (29%). During their stay, 109 patients died, primarily due to infectious complications (58%) and hemorrhage (17%). The mean APACHE II score was 20.79. The average length of stay was 20.59 days, ranging from 10 to 119 days. Factors associated with prolonged stay included age, chronic renal failure, and neurosurgical conditions. Prolonged ICU stays have significant economic and physical repercussions, with high rates of nosocomial infections and other complications. The length of stay is closely associated with increased morbidity and mortality, necessitating optimal patient care to minimize duration. Neurosurgical pathologies were a major cause of prolonged stays, with demographic factors like age and sex also playing a role. The study highlights that neurosurgical and traumatic reasons for admission, along with high APACHE II scores, significantly influence prolonged ICU stays. Efforts to reduce stay duration should include setting up weaning or post-intensive care units, especially for neurosurgical patients, to maintain specific care in a safe environment and reduce the economic impact of prolonged stays.