Predictors of Physical Restraint After Cardiac Surgery: A Retrospective Cohort Study

Background: This retrospective cohort study aimed to estimate the incidence of physical restraint (PR) among patients undergoing elective cardiac surgery, characterize the associated clinical features, and identify independent predictors of PR after transfer to the general ward. Methods: We analyzed data from 3941 adult patients at Beijing Anzhen (2018–2025). PR cases were identified through electronic medical records. Univariate and multivariable logistic regression analyses were performed to identify independent risk factors among perioperative variables. Model performance was evaluated using the C-statistic and the Hosmer–Lemeshow test, and internal stability was assessed via bootstrap resampling. Results: The overall incidence of PR was 5.2% (206/3941). Multivariable logistic regression identified four independent predictors: advanced age (adjusted odds ratio [aOR]: 1.04; 95% confidence interval [CI]: 1.02–1.05; p < 0.001), use of deep hypothermic circulatory arrest (DHCA) (aOR: 3.52; 95% CI: 1.90–6.51; p < 0.001), remimazolam for maintenance of anesthesia compared with propofol (aOR: 2.19; 95% CI: 1.15–4.18; p = 0.017), and prolonged length of stay in the intensive care unit (ICU) (aOR: 1.01; 95% CI: 1.01–1.01; p < 0.001). In an exploratory analysis restricted to patients aged ≥65 years, remimazolam maintenance was associated with higher odds of PR than propofol in a parsimonious Firth-penalized logistic regression model (adjusted OR, 5.29; 95% CI: 2.07–13.49; p < 0.001). Conclusions: Advanced age, DHCA procedures, remimazolam-based anesthesia, and extended ICU stays independently predict the use of PR in patients undergoing cardiac surgery. These findings may facilitate risk stratification and underscore the need for targeted perioperative interventions and careful anesthetic selection to minimize unnecessary restraint.