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Published on: June 14, 2024
Identifying Selected Mental Health, Physical, and Social Determinants of Extended Length of Stay After Elective
Francesca Biondi1, Julieta Aprosoff2, Grace Dowell3
1Francesca Biondi, MScPT, Physiotherapy Student, Department of Physical Therapy, University of Toronto, Ontario, Canada; PT Resident, Northern Proactive Health, Sudbury, Ontario, Canada; PT Resident, Active Therapy+, Sudbury, Ontario, Canada.
Insights
Extended hospital stays after cardiac surgery are linked to factors like female sex and the need for homecare. Preoperative screening should consider these determinants to improve patient recovery and resource allocation.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Cardiovascular disease is a leading cause of death in Canada, necessitating numerous open-heart surgeries annually.
- Optimal recovery post-cardiac surgery typically involves a 4-7 day hospital stay for safe discharge.
Purpose of the Study:
- To investigate associations between extended length of stay (LOS) after cardiac surgery and pre-operative determinants of health.
- To inform the development of a prescreening tool for identifying patients at risk of prolonged recovery.
Main Methods:
- A retrospective chart review of 250 patients undergoing elective cardiac surgery was performed.
- Patients were categorized by regular (≤4 days) and extended (>4 days) LOS.
- Demographic, clinical, mental, physical, and social variables were analyzed for associations with extended LOS.
Main Results:
- Factors associated with extended LOS included non-coronary artery bypass grafting (CABG) surgeries, female sex, impaired left ventricular function, and the need for postoperative homecare.
- Absence of a specialized medical home support program also correlated with longer hospital stays.
Conclusions:
- The standard 4-day in-hospital pathway may not suit all elective cardiac surgery patients.
- Preoperative assessment should incorporate factors like sex, left ventricular function, homecare needs, and support program availability to optimize patient outcomes and resource management.
Objective:
Cardiovascular disease is the second leading cause of death among Canadians, with approximately 40 000 open-heart surgeries such as coronary artery bypass grafting (CABG) and valve replacements performed annually. The best practices after cardiac surgery include a hospital stay of 4 to 7 days to facilitate safe discharge. We explored associations between an extended length of stay and selected mental, physical, and social determinants of health routinely collected before surgery, with the aim of informing the development of a future prescreening instrument to better identify patients at risk for prolonged recovery times.
Methods:
A single-center longitudinal retrospective chart review was conducted at Trillium Health Partners, a large urban center in Canada. A list of 250 randomized charts, half with regular length of stay (LOS) (≤4 days) and half with extended LOS (>4 days), indicating those who underwent elective cardiac surgery between November 2021 and August 2023 was analyzed. Demographic, clinical, mental, physical, and social variables were examined to identify their associations with extended LOS.
Results:
The study included 250 patients with a median age of 65 years (±12 years), 80% male, and 84% undergoing CABG. Factors associated with an extended LOS included cardiac surgeries other than CABG alone ( P = .002), female sex ( P = .038), left ventricular function >1 ( P = .024), need for postoperative homecare ( P = .028), and absence of a specialized medical home support program for patients' postcardiac surgery ( P = .017).
Conclusions:
The current in-hospital pathway of 4 days at our center may not be applicable to all patients undergoing elective cardiac surgery. These findings highlight the importance of considering sex, left ventricular function, need for homecare after surgery, and lack of specialized medical home support programs in preoperative screening and planning to improve resource allocation and patient outcomes.
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