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Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach
Zofia Zdanowicz1,2,3, Christina Laternser4, Colin J Crilly4
1Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA.
Journal of the American Heart Association
|May 30, 2026
Summary
Discharge barriers significantly increase length of stay (LOS) for infants after congenital heart surgery, impacting outcomes as much as clinical complexity. Addressing these barriers is key to improving patient recovery.
Area of Science:
- Pediatric Cardiology
- Health Services Research
- Healthcare Management
Background:
- Infants with severe congenital heart defects face complex postoperative care.
- Identifying discharge barriers is crucial for understanding length of stay (LOS) variation.
Purpose of the Study:
- To identify discharge barriers in infants post-congenital heart surgery.
- To compare the impact of discharge barriers versus clinical factors on postoperative LOS variation.
Main Methods:
- Retrospective cohort study of 752 infants (2015-2021) undergoing cardiac surgery at ≤12 months.
- Discharge barriers and clinical factors (complexity, complications, demographics) were analyzed for association with postoperative LOS.
- Shorrocks-Shapley decomposition quantified contributions to LOS variation.
Main Results:
- 24.3% of infants experienced discharge barriers, most commonly related to medical equipment or prior authorization delays.
- Median postoperative LOS was significantly longer for infants with barriers (26 days) vs. without (8 days).
- Discharge barriers and surgical complexity explained similar proportions of LOS variation (21.2% and 22.2%, respectively).
Conclusions:
- Discharge barriers are as influential as surgical complexity in explaining postoperative LOS variation.
- Mitigating modifiable discharge barriers may improve postoperative LOS for infants undergoing congenital heart surgery.
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