Postdischarge complications: what exactly happens when the patient goes home?

Economic implications favouring early discharge have led to an ever increasing demand to send patients home for recuperation. Patients are now routinely released on their fourth postoperative day, thereby making postdischarge complications harder to record and audit. We set about the use of a structured questionnaire to evaluate the incidence of all postdischarge complications requiring therapy within the first six weeks of convalescence. Over a 24-month period, 382 patients were questioned following cardiac surgery. Of these patients, 72% had an uneventful postoperative recovery, however, 17% needed treatment from their general practitioner, 6% were readmitted, 5% required district nurse treatment and 1% called the National Health Service advice line (NHS direct). Furthermore, despite the fact that 28% of discharges required further medical intervention in the majority of cases, cardiothoracic clinicians were not aware of complications requiring treatment. The auditing of these complications has resulted in changes in our surgical practice leading to a reduction in postoperative complications. Structured questionnaires are a useful tool in allowing improvement in surgical technique. They can be used by all members of the cardiothoracic team regardless of their grade and enable a methodical and reproducible assessment of all discharged patients.