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Determinants of discharge following coronary artery bypass graft surgery
H L Lazar1, K Wilcox, J R McCormick
1Department of Cardiothoracic Surgery, Boston University Medical Center.
Insights
Early discharge after coronary artery bypass graft (CABG) surgery is safe for select patients. Factors like female sex, older age, and major complications predict longer hospital stays following CABG.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
Background:
- The optimal discharge timing post-coronary artery bypass graft (CABG) surgery remains unclear.
- Hospitalization duration after CABG varies significantly across medical institutions.
Purpose of the Study:
- To identify factors differentiating early versus late discharge after CABG.
- To inform clinical decision-making regarding patient discharge protocols.
Main Methods:
- Retrospective analysis of 177 patients undergoing isolated CABG procedures.
- Patients categorized into three discharge groups: ≤8 days, 9-11 days, and ≥12 days.
- Chi-square analysis used to identify discriminating factors between early (≤8 days) and late (≥12 days) discharge.
Main Results:
- Female sex, unstable angina, congestive heart failure (CHF), age ≥65 years, and major postoperative complications discriminated between early and late discharge groups (p<0.05).
- No significant differences were observed in angina class, prior myocardial infarction, coronary artery disease extent, aortic cross-clamp time, graft number, ejection fraction, or minor complications.
- Early discharge (≤8 days) did not correlate with increased 60-day readmissions or return visits.
Conclusions:
- While early discharge (≤8 days) is feasible for some CABG patients, specific patient characteristics predict longer hospitalization.
- Identifying high-risk patients (female, ≥65 years, unstable angina, CHF, major complications) can guide discharge planning.
- This research supports tailored discharge strategies to optimize resource utilization and patient outcomes.
Abstract:
The optimal time for discharge following coronary artery bypass graft (CABG) surgery is uncertain and varies among institutions. This study was undertaken to determine what factors may discriminate between early and late discharge following surgery. In 177 consecutive patients undergoing isolated CABG procedures, three groups were formed retrospectively according to the number of days hospitalized post CABG: group 1, less than or equal to 8; group 2, 9 to 11; group 3, greater than or equal to 12. Parameters found to discriminate between group 1 and group 3 (p less than .05; chi square analysis) included female sex, unstable angina, congestive heart failure (CHF), age greater than or equal to 65 years, and the development of major postoperative complications. Angina class, prior myocardial infarction, extent of coronary artery disease, aortic cross-clamp time, number of bypass grafts, ejection fraction less than 40 percent, or "minor" postoperative complications were not different among groups. Patients discharged less than or equal to 8 days following CABG had no increase in return visits or readmissions less than 60 days post CABG. We conclude that while certain patients can be safely discharged less than or equal to 8 days post CABG, patients who are female, greater than or equal to 65 years, have unstable angina, CHF, or a major postoperative complication are likely to be hospitalized longer.