Obstacles to early discharge after cardiac surgery

Context: Cardiovascular disease and cardiac surgery, in particular, are associated with a large expenditure of healthcare resources. Identifying the factors that affect length of stay for patients hospitalized for cardiac surgery and ways to safely and effectively shorten stays could have significant impact on healthcare costs. Objective: To identify obstacles to and the effects of early discharge on outcome after cardiac surgery. Study Design: A prospective approach using a protocol consisting of modifying anesthesia, limiting the use of postoperative narcotics, early extubation, and early mobilization, with a goal of discharge at < 5 days. Patients and Methods: The study group consisted of 422 consecutive patients (age range 15- 89 years, 65% males): coronary artery bypass graft (CABG) (n = 290), valve procedures (n = 54), and CABG + valve procedures (n = 78). The discharge criteria included hemodynamic stability, normal bowel function, independence in activities of daily living, absence of fever, and no incision problems. Results: Predictors of prolonged postoperative stay were prolonged intensive care unit stay (P < 0.0001), postoperative atrial fibrillation (P = 0.0006), preoperative congestive heart failure (P = 0.002), combined CABG and valve procedure (P = 0.005), prolonged ventilator support (P = 0.01), increasing age (P = 0.012), history of peripheral vascular disease (P = 0.02), and female gender (P = 0.025). The 30-day readmission rate for the early discharge group was 7.8% vs 16.2% for the late discharge group (P = 0.01). The mortality rate for the entire group was 3.3%. Conclusion: We have identified several obstacles to early discharge after cardiac surgery. Future efforts can be directed toward minimizing their impact on postoperative length of stay.