Shared care for open heart surgery: 21 years' experience

Area of Science:

• Cardiovascular Surgery
• Healthcare Management

Background:

• Open heart surgery, primarily coronary artery bypass grafting (CABG), involves extended postoperative stays at specialized surgical centers.
• Transferring patients back to their referring hospitals for postoperative care is a potential strategy to optimize resource utilization and patient flow.

Purpose of the Study:

• To evaluate the safety and feasibility of early patient transfer for postoperative care after open heart surgery to a referring nonspecialized hospital.
• To identify benefits and assess the impact of this shared care model on patient outcomes and healthcare system efficiency.

Main Methods:

• A retrospective study of 1696 patients undergoing open heart surgery (predominantly CABG) between 1971 and 1992.
• Analysis of postoperative length of stay, perioperative mortality, major complications, and patient transfer protocols.

Main Results:

• Postoperative stay at the surgical hospital was significantly reduced (from 10.4 to 2.4 days), leading to an 18% decrease in combined hospital time.
• No cardiovascular complications were linked to patient transfer, and postoperative deaths in the referring hospital were not attributed to early transfer.
• Overall perioperative mortality was 2.7%, with lower rates for isolated primary CABG (1.3%) compared to reoperations (7.7%).

Conclusions:

• Early transfer of patients after open heart surgery to a smaller, nonspecialized hospital for postoperative care is safe and feasible.
• The shared care model demonstrates significant benefits, including reduced hospital stays and efficient resource allocation.
• This collaborative approach offers valuable insights for designing and improving cardiac surgical care programs.