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Safety of Early Discharge After Coronary Artery Bypass Grafting: A Nationwide Readmissions Analysis
Paige E Brlecic1, Katie J Hogan2, John A Treffalls3
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Insights
Early discharge after coronary artery bypass grafting (CABG) is safe for select patients, showing lower readmission rates and costs compared to routine discharge. This approach can reduce infections and improve outcomes when carefully managed.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Patient Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a major surgical procedure.
- Assessing early discharge safety and outcomes is crucial for patient care optimization.
Purpose of the Study:
- To determine the safety and compare outcomes of early discharge versus routine discharge after uncomplicated CABG.
- To identify preoperative factors associated with readmission following early discharge after CABG.
Main Methods:
- Utilized the Nationwide Readmissions Database (2016-2018) for patients undergoing CABG.
- Stratified patients into early (≤4 days) and routine (5-10 days) length of stay (LOS) cohorts, excluding complicated cases.
- Employed propensity score matching and multivariable logistic regression to compare outcomes and identify readmission predictors.
Main Results:
- Early discharge (≤4 days) was applied to 31% of uncomplicated CABG patients.
- Early discharge was associated with significantly lower 30-day, 90-day, and 1-year readmission rates (P < .001).
- Early discharge resulted in lower hospitalization costs and a reduced incidence of nosocomial infection and readmission from infection.
Conclusions:
- Early discharge after uncomplicated CABG is feasible and safe in a highly selective patient group.
- Early discharge patients demonstrate reduced readmission rates, particularly for infections, compared to routine discharge.
- Further development of postdischarge processes is recommended to support early discharge after CABG.
Background:
We determined the safety of early discharge after coronary artery bypass grafting (CABG) in patients with uncomplicated postoperative courses and compared outcomes with routine discharge in a national cohort. We identified preoperative factors associated with readmission after early discharge after CABG.
Methods:
The Nationwide Readmissions Database was queried to identify patients undergoing CABG from January 2016 to December 2018. Patients were stratified based on length of stay (LOS) as early (≤4 days) vs routine (5-10 days) discharge. Patients were excluded with hospital courses indicative of complicated stays (emergent procedures, LOS >10 days, discharge to extended care facility or with home health, index hospitalization mortality). Propensity score matching was performed to compare outcomes between cohorts. Multivariable logistic regression models were used to identify factors associated with readmission after early discharge.
Results:
During the study period, 91,861 patients underwent CABG with an uncomplicated postoperative course (∼20% of CABG population). Of these, 31% (28,790 of 91,861) were discharged early, and 69% (63,071 of 91,861) were routinely discharged. After propensity score matching, patients discharged early had lower readmission rates at 30 days, 90 days, and up to 1 year (P < .001 for all). The index hospitalization cost was lower with early discharge ($26,676 vs $32,859; P < .001). Early discharge was associated with a lower incidence of nosocomial infection at the index hospitalization (0.17% vs 0.81%, P < .001) and readmission from infection (14.5% vs 18%, P = .016).
Conclusions:
Early discharge after uncomplicated CABG can be considered in a highly selective patient population. Early-discharge patients are readmitted less frequently than matched routine-discharge patients, with a lower incidence of readmission from infection. Appropriate postdischarge processes to facilitate early discharge after CABG should be further pursued.
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