Outcomes of 3-day discharge after elective cardiac surgery

Andre Y. Son, Azad S. Karim, Monica Fiehler, Adin Cristian Andrei, Patricia Vassallo, Andrei Churyla, Duc Thinh Pham, Patrick M. McCarthy, S. Chris Malaisrie*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Shorter length of stay (LOS) is a welcome consequence of optimized perioperative care. However, accelerated hospital discharge may have unintended consequences. Before implementing an institutional enhanced recovery after surgery protocol, we evaluated the safety of shorter LOS and compared outcomes of patients with shorter LOS (LOS ≤ 3 days) to those with longer LOS (LOS > 3 days). Methods: We identified all patients undergoing elective cardiac surgery with cardiopulmonary bypass between July 2004 and June 2017. Transcatheter approaches, ventricular assist devices, transplants, and traumas were excluded. Patients were divided into two cohorts, one with shorter hospitalizations (LOS ≤ 3 days) and one with longer hospitalizations (LOS > 3 days). Propensity score matching (PSM) was performed and differences between the two groups were compared. Results: A total of 5,987 patients (63.0 ± 13.8 years old, 34% female) were identified and 131 (2.2%) patients were LOS ≤ 3 days; median STS Risk score was 1.2 (0.6–2.4). PSM resulted in a total of 478 patients (357 LOS > 3 and 121 LOS ≤ 3 days); median STS Risk score was 0.4 (0.3–0.9). LOS ≤ 3 days had lower rates of postoperative atrial fibrillation (2% vs. 19%; p <.001) and major in-hospital complications (0% vs. 9%; p =.001); however, 30-day readmissions (8% LOS ≤ 3 vs. 6% LOS > 3 days; p =.66) and mortality rates (0% vs. 0%) were comparable between the two groups. Conclusion: LOS ≤ 3 days was associated with less postoperative atrial fibrillation and fewer major in-hospital complications. LOS ≤ 3 days was not associated with rehospitalization or mortality. Shorter LOS after elective cardiac surgery appears to be a safe practice with favorable outcomes, especially in low operative risk patients.

Original languageEnglish (US)
Pages (from-to)1441-1447
Number of pages7
JournalJournal of Cardiac Surgery
Volume36
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • cardiovascular research

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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