Early Discharge After Cardiac Surgery Not Associated With Worse Outcomes: Presented at STS

By Nancy Shaw

NEW ORLEANS -- January 29, 2020 -- Patients undergoing elective cardiac surgery with cardiopulmonary bypass who are discharged early -- in 3 days or less -- do not have worse outcomes or higher readmission rates than patients who stay in the hospital for a longer amount of time, according to a study presented here at the 56th Annual Meeting of the Society of Thoracic Surgeons (STS).

“We have shown that long hospital stays after heart surgery are no longer necessary, and patients can go home safely after just a few days in the hospital,” said S. Chris Malaisrie, MD, Northwestern University, Chicago, Illinois. “This information helps pave the way for the introduction of a cardiac Enhanced Recovery After Surgery program. The use of such a strategy is feasible.”

Recent guidelines from the Enhanced Recovery After Surgery (ERAS) Society suggest strategies to shorten hospital stay and time in the intensive care unit. To further evaluate the safety of shorter hospital lengths of stay following elective cardiac surgery, Dr. Malaisrie and colleagues analysed data from patients who underwent cardiac surgery between July 2004 and June 2017. The study excluded transcatheter approaches, ventricular assist device procedures, transplants, and trauma patients.

A total of 121 patients had a length of stay of ≤3 days after surgery. Utilising propensity score matching (1:3), the researchers compared these patients with 357 patients who also had elective cardiac surgery but had a hospital length of stay >3 days.

Results showed no significant differences between patients who stayed ≤3 days versus those who stayed >3 days for 30-day mortality (0% vs 0%), in-hospital major morbidity (3% vs 30%), or the need for a permanent pacemaker before discharge (0% vs 1%).

Postoperative atrial fibrillation rates were significantly higher in those with longer hospital stays (19% vs 2%; P

The results of the current study indicate that ERAS protocols may be implemented without concern for shorter hospitalisations.

“Multiple interventions are required for the success of an ERAS program,” noted Dr. Malaisrie. “There is no single magic bullet. Instead, it is through cumulative efforts that ERAS is successful for the patient. We would like to see the care of heart surgery patients be focused more on improving outcomes from the patient’s perspective and less from the physician’s [perspective].”

[Presentation title: Early Discharge Is Not Associated With Worse Outcome and Readmission: a Preview of Enhanced Recovery After Cardiac Surgery. Abstract 2]

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