IMPACT OF EARLY DISCHARGE AFTER CORONARY-ARTERY BYPASS GRAFT-SURGERY ON RATES OF HOSPITAL READMISSION AND DEATH

Objectives. This study examined the impact of early hospital discharge on short term clinical outcomes of elderly patients treated with coro nary artery bypass graft surgery (CABG) in the United States in 1992. Background. Protocols that encourage earlier discharge of patients who have had CABG have been implemented across the country. Although deli very of efficient care benefits both patients and providers, premature discharge can adversely affect clinical outcomes, resulting in increa sed hospital readmissions and higher long-term costs. Methods. We exam ined the prevalence of early discharge (postoperative length of stay l ess than or equal to 5 days) among 83,347 non-health maintenance organ ization (HMO) Medicare patients who underwent CABG in the United State s in 1992. Using logistic regression models, we identified patient cha racteristics associated with early discharge and obtained risk adjuste d rates of death and readmission or death for postoperative lengths of stay between 4 and 14 days. Results. In 1992, 6% of Medicare patients undergoing CABG were discharged within 5 days of the operation. The p revalence of early discharge varied considerably among states, ranging from 1% to 21%. Patients discharged early tended to be younger and ma le and have fewer comorbid illnesses. Risk-adjusted rates of death and death or cardiovascular readmission were lowest among patients discha rged early. Conclusions. As of 1992, early discharge of elderly patien ts treated with CABG in non-HMO settings was not associated with highe r 60-day rates of death or readmission. This suggests that physicians were able to identify low risk candidates for early discharge. Variati on across the nation in early discharge rates, along with the percenta ge of patients without major risk factors for adverse outcomes, sugges ts that higher rates of early discharge might be safely achieved. (C) 1997 by the American College of Cardiology.