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Obstacles to early discharge after cardiac surgery
N J Nickerson1, S F Murphy, V G Dávila-Román
1Heart Center, Missouri Baptist Medical Center, BJC Health System, St. Louis, USA.
The American Journal of Managed Care
|May 27, 1999
Summary
Early discharge after cardiac surgery is safe and effective. A protocol focusing on early mobilization and extubation reduced hospital stays without increasing readmissions, impacting healthcare costs.
Area of Science:
- Cardiology
- Thoracic Surgery
- Healthcare Management
Background:
- Cardiac surgery incurs significant healthcare costs.
- Reducing length of stay (LOS) can decrease expenditure.
- Identifying factors influencing LOS is crucial for cost containment.
Purpose of the Study:
- To identify obstacles to early discharge after cardiac surgery.
- To evaluate the effects of early discharge on patient outcomes.
Main Methods:
- Prospective study of 422 cardiac surgery patients.
- Protocol included modified anesthesia, limited narcotics, early extubation, and early mobilization.
- Discharge criteria focused on stability and patient independence.
Main Results:
- Predictors of prolonged LOS included ICU stay, atrial fibrillation, congestive heart failure, and combined procedures.
- Early discharge group had a significantly lower 30-day readmission rate (7.8% vs. 16.2%).
- Overall mortality rate was 3.3%.
Conclusions:
- A protocol for early discharge (<5 days) is feasible and safe after cardiac surgery.
- Early discharge is associated with reduced readmission rates.
- Optimizing patient management can lead to shorter hospital stays and potentially lower healthcare costs.