Derful GÜLEN, Serpil EKİN, Masood IQBAL, İlkay CEYLAN, Anıl ONUR, Gürcan GÜLER, Nigar MEHMET, Buket ÖZYAPRAK, Gönül ERKAN
The European Research Journal - 2026;12(8):925-937
Objective: Prolonged intensive care unit (ICU) stay following cardiac surgery is associated with increased morbidity, mortality, and healthcare resource utilization. This study aimed to identify preoperative and intraoperative factors associated with prolonged ICU stay after open heart surgery. Methods: This retrospective nested case-control study included 147 adult patients who underwent open heart surgery with cardiopulmonary bypass between January 2024 and December 2025. Patients were classified as prolonged ICU stay (>=5 days, n=50) or non-prolonged ICU stay (<5 days, n=97). Demographic, clinical, laboratory, and perioperative variables were analyzed. Univariable and multivariable logistic regression analyses were performed to identify independent factors associated with prolonged ICU stay. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the discriminative performance of key variables. Results: Patients with prolonged ICU stay had higher EuroSCORE II values, lower left ventricular ejection fraction (LVEF), higher preoperative creatinine levels, lower albumin levels, longer cardiopulmonary bypass (CPB) duration, and more complex surgical procedures. Multivariable analysis identified higher EuroSCORE II (OR=2.14; 95% CI: 1.42-3.22; P=0.002), lower LVEF (OR=1.42 per 5% decrease; 95% CI: 1.15-1.76; P=0.012), elevated creatinine (OR=6.84; 95% CI: 2.15-21.78; P=0.005), lower albumin (OR=4.12; 95% CI: 1.08-15.65; P=0.038), longer CPB duration (OR=1.28 per 10 minutes; 95% CI: 1.04-1.57; P=0.041), and complex surgical procedures as independent factors. EuroSCORE II demonstrated high discriminative performance (AUC=0.981), while CPB duration showed intermediate performance (AUC=0.750). Conclusion: Both preoperative physiological reserve and intraoperative variables contribute to prolonged ICU stay after cardiac surgery in a multifactorial manner. These findings may support perioperative risk stratification and ICU resource planning, though prospective validation in larger cohorts is warranted.
