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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.
Insights
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.
Context:
Cardiovascular disease and cardiac surgery, in particular, are associated with a large expenditure of healthcare resources. Identifying the factors that affect length of stay for patients hospitalized for cardiac surgery and ways to safely and effectively shorten stays could have significant impact on healthcare costs.
Objective:
To identify obstacles to and the effects of early discharge on outcome after cardiac surgery.
Study Design:
A prospective approach using a protocol consisting of modifying anesthesia, limiting the use of postoperative narcotics, early extubation, and early mobilization, with a goal of discharge at < 5 days.
Patients And Methods:
The study group consisted of 422 consecutive patients (age range 15-89 years, 65% males): coronary artery bypass graft (CABG) (n = 290), valve procedures (n = 54), and CABG + valve procedures (n = 78). The discharge criteria included hemodynamic stability, normal bowel function, independence in activities of daily living, absence of fever, and no incision problems.
Results:
Predictors of prolonged postoperative stay were prolonged intensive care unit stay (P < 0.0001), postoperative atrial fibrillation (P = 0.0006), preoperative congestive heart failure (P = 0.002), combined CABG and valve procedure (P = 0.005), prolonged ventilator support (P = 0.01), increasing age (P = 0.012), history of peripheral vascular disease (P = 0.02), and female gender (P = 0.025). The 30-day readmission rate for the early discharge group was 7.8% vs 16.2% for the late discharge group (P = 0.01). The mortality rate for the entire group was 3.3%.
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