Early discharge after coronary artery bypass graft surgery: Are patients really going home earlier?

Lazar, Harold L.; Fitzgerald, Carmel; Ahmad, Tazeen; Bao, Yusheng; Colton, Theodore; Shapira, Oz M.; Shemin, Richard J.

doi:10.1067/mtc.2001.113751

Cited by 59 publications

(37 citation statements)

References 17 publications

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“…Knowing these correlations can be effective in reducing the length of ICU stay (4). Some measures such as early tracheal extubation can reduce the length of stay in ICU (5); however, there will be some concern that earlier discharge might increase the probability of readmission in ICU (6). Readmission in ICU is usually accompanied with increased hospital mortality and might have poor outcomes (4).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing prolonged icu stay after open heart surgery

Azarfarin¹,

Ashouri²,

Totonchi³

et al. 2014

Res Cardiovasc Med

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Background:There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery.Objectives:The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay in a large referral hospital.Patients and Methods:We conducted a case-control study to determinate causes of prolonged ICU stay in 280 adult patients undergoing cardiac surgery in a tertiary care center for cardiovascular patients, Tehran, Iran. These patients were divided into two groups according to ICU stay ≤ 96 and > 96 hours. We evaluated perioperative risk factors of ICU stay > 96 hours.Results:Among the 280 patients studied, 184 (65.7%) had stayed ≤ 96 hours and 96 (34.3%) had stayed > 96 hours in ICU. Frequency of prolonged ICU stay was 34.2% in patients undergoing coronary artery bypass graft (CABG), 30.8% in patients with valve surgery, and 44.8% in patients with CABG plus valve surgery. Patients with > 96 hours of ICU stay received more blood transfusion and intravenous inotropes. They also had longer anesthesia, cardiopulmonary bypass, and postoperative intubation time. There were higher incidence of postoperative tamponade, re-exploration, re-intubation, hemodialysis, and hypotension in this group (P < 0.05 for all comparisons).Conclusions:In this study, about one-third of patients had prolonged ICU stay. Factors influencing prolonged ICU stay were medical and some non-medical factors. In the present study, up to 30% of the patients had a prolonged ICU stay of > 96 hours. Additional data from well-designed investigations are needed for further assessment of the factors influencing prolonged ICU stay after cardiac surgery.

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Section: Introductionmentioning

confidence: 99%

Factors influencing prolonged icu stay after open heart surgery

Azarfarin¹,

Ashouri²,

Totonchi³

et al. 2014

Res Cardiovasc Med

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“…22 Lazar and colleagues found that a significantly higher percentage of CABG cases were discharged to extended care facilities in 1998 compared to 1990 (43.3% versus 2.9%). 23 Their study, although important in highlighting discharge disposition, was limited to 786 patients in a single center in an urban setting. Hannan et al reported that discharge to a skilled nursing facility or rehabilitation hospital was significantly associated with hospital readmission within 30 days of the index CABG procedure.…”

Section: Increase In Nonroutine Dischargesmentioning

confidence: 99%

Increasing Healthcare Resource Utilization After Coronary Artery Bypass Graft Surgery in the United States

Swaminathan

Phillips-Bute

Patel

et al. 2009

Circ: Cardiovascular Quality and Outcomes

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Background-Despite declining lengths of stay, postdischarge healthcare resource utilization may be increasing because of shifts to nonacute care settings. Although changes in hospital stay after coronary artery bypass graft (CABG) surgery have been described, patterns of discharge remain unclear. Our objective was to determine patterns of discharge disposition after CABG surgery in the United States. Methods and Results-We examined discharge disposition after CABG procedures from 1988 to 2005 using the Nationwide Inpatient Sample. Discharges with a "nonroutine" disposition defined patients discharged with continued healthcare needs. Multivariable regression models were constructed to assess trends and factors associated with nonroutine discharge. Median length of stay among 8 398 554 discharges decreased from 11 to 8 days between 1988 and 2005 (PϽ0.0001). There was a simultaneous increase in nonroutine discharges from 12% in 1988 to 45% in 2005 (PϽ0.0001), primarily comprising home healthcare and long-term facility use. Multivariable regression models showed age, female gender, comorbidities, concurrent valve surgery, and lower-volume hospitals more likely to be associated with nonroutine discharge. Conclusions-We found a significant increase in nonroutine discharges after CABG surgery across the United States from 1988 to 2005. The significant shortening of length of stay during CABG may be counterbalanced by the increased requirement for additional postoperative healthcare services. Nonacute care institutions are playing an increasingly significant role in providing CABG patients with postdischarge healthcare and should be considered in investigations of postoperative healthcare resource utilization. The impact of these changes on long-term outcomes and net resource utilization remain unknown. (Circ Cardiovasc Qual Outcomes. 2009;2:305-312.)Key Words: coronary disease Ⅲ surgery Ⅲ bypass Ⅲ epidemiology Ⅲ mortality A pproximately 500 000 coronary artery bypass graft (CABG) procedures are performed annually in the United States 1 at a substantial cost to the healthcare system. Several quality improvement initiatives have sought to improve process measures and outcomes. [2][3][4] In the 1990s, in an effort to improve efficiency and potentially reduce cost, postoperative length of stay (LOS) was decreased through enthusiastic adoption of "fast-track" protocols. Several studies documented successful implementation of these initiatives with subsequent reductions in perioperative resource utilization. [5][6][7][8][9][10] The impact of reduction in LOS has also been examined with regard to both costs and effect on readmission and postoperative morbidity. 11 Despite shorter LOS, concurrent quality improvement programs have reported simultaneous reductions in postoperative mortality after CABG surgery. 3 However, few studies have examined postoperative discharge disposition in this setting.In New York State, postoperative LOS was found to have decreased after CABG surgery with a concurrent increase in transfer to nonacut...

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“…In Zeiten stetig steigender Kosten im Gesundheitswesen und einer Verknappung von Ressourcen, insbesondere im Bereich der intensivmedizinischen Kapazitäten, rücken ökonomische Aspekte eines operativen Verfahrens zunehmend in den Mittelpunkt des Interesses. Obwohl der klinische Nutzen der "Fast-track-" und sogar "Ultra-fast-track-Regime" in der Kardiochirurgie mit der Extubation auf dem OP-Tisch nach wie vor umstritten ist [39,49], existieren erste Fallberichte von Patienten, bei denen ein herzchirurgischer Eingriff in ACAB-Technik als "day case surgery" durchgeführt wurde. Inwieweit sich jedoch die Ergebnisse der Untersuchung von Karagoz et al aus dem türkischen Ankara auf das deutsche Gesundheitswesen übertragen lassen, bleibt zweifelhaft.…”

Section: "Pros Und Cons"unclassified

Koronare Bypasschirurgie am wachen Patienten

Byhahn

Meininger²,

Kessler³

2008

Anaesthesist

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Patients undergoing coronary artery bypass grafting increasingly show severe co-morbidities, which can negatively affect the outcome. Recent developments in cardiac surgery have therefore focused on minimizing the invasiveness of the procedure by revascularization on the beating heart without cardiopulmonary bypass, and by reducing surgical trauma using smaller surgical incisions. Progress in minimally invasive cardiac surgery has led to minimally invasive anesthesia, i.e. using high thoracic epidural anesthesia as the sole technique in the conscious patient (awake coronary artery bypass grafting, ACAB). Published data on ACAB procedures in smaller cohorts have demonstrated that the procedure is safe. Significant complications occurred in 7.1% of patients. A particular cause of concern during ACAB surgery is the development of spinal epidural hematoma the risk of which has been estimated to be as high as 1:1,000. A thorough risk-benefit analysis has therefore to be made. Currently, ACAB surgery remains limited to few specialized centers and highly selected patients.

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Early discharge after coronary artery bypass graft surgery: Are patients really going home earlier?

Abstract: Early extubation and fast track protocols have resulted in earlier discharge from acute care facilities. However, the anticipated earlier return to home has been offset by the increased use of outpatient nursing services, discharges to extended care facilities, and hospital readmissions.

Cited by 59 publications

References 17 publications

Factors influencing prolonged icu stay after open heart surgery

Factors influencing prolonged icu stay after open heart surgery

Increasing Healthcare Resource Utilization After Coronary Artery Bypass Graft Surgery in the United States

Koronare Bypasschirurgie am wachen Patienten

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