HOSPITAL READMISSION AFTER CARDIAC-SURGERY - DOES FAST-TRACK CARDIAC-SURGERY RESULT IN COST-SAVING OR COST SHIFTING

Background-Intense medical and economic pressures have created ''fast track'' cardiac surgery in which clinical services are streamlined and early discharge is encouraged. Does this strategy promote significant cost saving or merely cost shifting? In a global system of reimbursem ent, the economic benefit of decreasing patient length of stay may be offset by high rates of patient readmission. This study was undertaken to determine the 30-day readmission rate after cardiac surgery and to analyze trends of readmission diagnoses. Methods and Results-From Oct ober 1, 1996 to July 31, 1997, 460 consecutive cardiac surgical operat ions were performed at 1 institution. There were 25 deaths and 8 patie nts who remained as inpatients at the 30-day postoperative deadline fo r readmission. Two patients had 2 operations. Therefore, 527 operation s were performed on 525 patients. There were 110 readmissions after 52 7 operations for a readmission rate of 20.9%. A significant number of readmissions (49%) were to outside hospitals. Readmission diagnoses we re: atrial fibrillation (23%); angina, congestive heart failure, or ve ntricular tachycardia (20%); leg wound (15%); sternal wound (5%); pneu monia (5%); gastrointestinal complaints (5%); neurologic event (2%); a nd miscellaneous (25%). Patients discharged greater than or equal to 7 days postoperatively were twice as likely to be readmitted as those d ischarged on postoperative days 4, 5, or 6. Conclusions-Readmission af ter cardiac surgery is common and frequently (49%) to outside institut ions. Patients discharged greater than or equal to 7 days postoperativ ely represent the patients at greatest risk of readmission and, theref ore, warrant closer scrutiny before discharge.