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J Thorac Cardiovasc Surg 2001;121:943-950
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

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

From the Department of Cardiothoracic Surgery, The Boston Medical Center and the Boston University School of Medicine, Boston, Mass.

Received for publication May 4, 2000. Revisions requested July 17, 2000;. revisions received Nov 30, 2000. Accepted for publication Dec 5, 2000. Address for reprints: Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Boston Medical Center, Suite B404, 88 E Newton St, Boston, MA 02118 (E-mail: harold.lazar{at}bmc.org).

Objective: This study was undertaken to determine whether early discharge after coronary artery bypass grafting allows patients to return home earlier or merely increases the use of outpatient nursing and inpatient rehabilitation services.
Methods: Patterns of discharge were analyzed in 407 patients undergoing bypass grafting in 1990, when there were no early extubations or fast track protocols, and compared with 379 patients in 1998, when these protocols were used.
Results: Patients in 1998 had a higher prevalence of class IV angina (35.3% vs 22.8%; P = .006), urgent/emergency surgery (58.3% vs 44.9%; P = .015), and lower ejection fractions (48.9% ± 16.4% vs 52.9% ± 13.5%; P = .0002). Despite these increased risk factors, 1998 patients spent less time receiving ventilatory support (10.2 ± 9.2 vs 26.7 ± 15.7 hours; P < .001) and had a shorter length of stay (5.4 ± 2.5 vs 9.2 ± 4.3 days; P < .001). However, fewer 1998 patients were discharged home (56.7% vs 97.0%; P < .0001). A higher percentage of 1998 patients (43.3% vs 2.9%; P < .00001) were discharged to extended care facilities where their average length of stay was 10.6 ± 15.1 days. Readmission to the Boston Medical Center was also more common in 1998 patients (5.3% vs 0.5%; P < .0001).
Conclusions: 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.

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