Predictors and clinical outcomes associated with prolonged mechanical ventilation following major cardiac surgery

Abstract

Background: Prolonged mechanical ventilation (PMV) after major cardiac surgery is associated with increased morbidity, mortality, and healthcare utilization. Objectives: To determine independent perioperative predictors of PMV and assess its impact on postoperative outcomes in cardiac surgical patients. Methods: This retrospective case-control study analyzed 1437 adults undergoing major cardiac surgery in 2022. PMV was defined as ventilation >24 h postoperatively. Multivariable logistic regression identified independent predictors; outcomes were adjusted using inverse probability of treatment weighting. Results: PMV occurred in 167 patients (11.6%). Independent preoperative predictors were mechanical ventilation (OR 5.632, 95% CI 1.208-26.262, P = 0.028) and urgent admission (OR 2.520, 95% CI 1.292-4.844, P = 0.007). Intraoperative predictors included prolonged cardiopulmonary bypass duration and aortic surgery. Postoperative factors associated with PMV were neurologic complications (OR 3.90, 95% CI 1.771-8.590, P = 0.001), acute kidney injury (OR 3.548, 95% CI 1.214-10.374, P = 0.021), transfusion volume (OR 1.043, 95% CI 1.016-1.071, P = 0.002), and continuous sedation duration (OR 1.038, 95% CI 1.026-1.050, P < 0.001). Delirium by Confusion Assessment Method - ICU was not significant (P = 0.053), whereas higher Numeric Rating Scale pain scores were inversely associated with PMV (OR 0.81, 95% CI 0.694-0.945, P = 0.008). PMV was linked to higher reintubation, higher ICU readmission, longer ICU stay (mean difference [MD] 7.4 d, P < 0.001), and extended hospitalization (MD 17.4 d, P < 0.001). Conclusions: PMV is associated with multiple modifiable perioperative factors and adverse outcomes. Early risk stratification and targeted preventive strategies may improve recovery and survival in this population.