Shorter length of stay after cardiac surgery may be safe
A shorter length of stay of 3 days or less was safe for patients who underwent elective cardiac surgery, according to a poster presented at The Society of Thoracic Surgeons Annual Meeting and Exhibition.
“This sort of clears the path for us starting an enhanced recovery after surgery (ERAS) protocol,” S. Chris Malaisrie, MD, professor of surgery in the division of cardiac surgery at Northwestern University Feinberg School of Medicine, said during a press conference. “It does answer some pertinent questions from both the patient and our administration about, ‘Well, if I get sent home too early, will I have any problems if I go home?’ That can be safely answered, ‘No.’ Your hospital administrator may ask, ‘Are we going to have an unintended consequence of readmission because we sent patients home?’ The answer to that is also, ‘No.’”
Researchers analyzed data from 478 propensity-matched patients who underwent elective cardiac surgery between 2004 and 2017. Length of stay was categorized as 3 or less days (n = 121; mean age, 51 years; 18% women) or more than 3 days (n = 357; mean age, 51 years; 15% women).
The median length of stay for all patients (n = 5,987) was 6 days, with 2.2% staying in the hospital for 3 days or less.
“We think [6 days] is a very good length of stay after cardiac surgery,” Malaisrie said during the press conference.
There were no statistically significant differences among patients with longer lengths of stay vs. shorter lengths of stay regarding 30-day mortality (0% vs. 0%; P = .56), stroke (1% vs. 0%, respectively; P = .19), renal failure (1% vs. 0%, respectively; P = .41) or prolonged ventilator use (3% vs. 0%, respectively; P = .08). No differences were also seen for reoperation for bleeding (3% vs. 0%, respectively; P = .06). In-hospital major morbidity occurred in 7% of patients with a length of stay more than 3 days compared with 0% in those with a length of stay less than 3 days (P = .001).
Long-term survival between the longer vs. shorter length of stay were similar at 1 year (98.9% vs. 100%, respectively) and up to 10 years (90.2% vs. 94.8%, respectively; P = .1). Readmission within 30 days after discharge was also similar in the longer length of stay group vs. the shorter length of stay group (6% vs. 8%, respectively).
Patients discharged earlier had a lower rate of postoperative atrial fibrillation vs. those discharged later (2% vs. 19%; P < .001).
“I just want to remind people that it is just an association, and we can’t demonstrate any causality between discharge and postoperative atrial fibrillation,” Malaisrie said during the press conference. – by Darlene Dobkowski
Malaisrie SC. Abstract 340. Presented at: The Society of Thoracic Surgeons Annual Meeting and Exhibition; Jan. 25-28, 2020; New Orleans.
Disclosure: Malaisrie reports he has relationships with Abbott, CryoLife, Edwards Lifesciences and Terumo Aortic.