Prolonged Mechanical Ventilation and In-Hospital Mortality Following Open-Heart Surgery: A Retrospective Cohort Study

Background: Prolonged mechanical ventilation (PMV) after open-heart surgery is associated with adverse postoperative outcomes, but evidence regarding its association with mortality in Indonesia remains limited. This study evaluated the association between PMV and in-hospital mortality and identified factors associated with PMV. Methods: A retrospective cohort study was conducted among adults undergoing open-heart surgery at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between 2023 and 2024. PMV was defined using two thresholds (> 24 h and ≥ 96 h). Factors associated with mortality were evaluated using univariable and multivariable logistic regression. Results: A total of 249 patients were included, with an in-hospital mortality rate of 18.9%. PMV occurred in 62.2% (> 24 h) and 5.6% (≥ 96 h) of patients. In multivariable analysis, PMV > 24 h (adjusted odds ratio (aOR) 3.259, 95% confidence interval (CI) 1.438–7.386; P = 0.005) and longer operative duration (aOR 1.009, 95% CI 1.004–1.015; P = 0.001) were associated with in-hospital mortality after adjustment. Using the ≥ 96-h definition, PMV (aOR 15.422, 95% CI 4.112–57.844; P < 0.001), operative duration (aOR 1.009, 95% CI 1.003–1.014; P = 0.002), and age (aOR 1.037, 95% CI 1.000–1.075; P = 0.049) remained associated with in-hospital mortality after adjustment. No statistically significant factors associated with PMV were identified. Conclusions: PMV was associated with increased in-hospital mortality following open-heart surgery, with a stronger association for ventilation ≥ 96 h. Longer operative duration also predicted mortality, highlighting the importance of perioperative risk stratification and optimized postoperative ventilatory management.