Objectives: Early discharge has been proposed as a means of containing the
escalating cost of health care in cardiac surgery. The aim of this study wa
s to investigate whether shortening the length of hospital stay after coron
ary artery bypass surgery is safe and cost effective. Methods: Patients (n
= 198) undergoing elective bypass surgery by two surgeons for a period of 1
2 months were prospectively entered into the study but not randomized. The
anaesthetic and surgical treatments were identical in all patients with the
exception that one of the surgeons used intermittent cold crystalloid card
ioplegia ('normal discharge' group; n = 119) and the other used intermitten
t ischaemia without cardioplegia ('early discharge' group; n = 79). Previou
s to the study both surgeons discharged patients on the 7th-8th postoperati
ve day. For the present study, one of the two surgeons adopted the new poli
cy of discharging patients on the 4th postoperative day ('early discharge'
group). The criteria for hospital discharge included: presence of sinus rhy
thm, absence of pyrexia and wound infection, normal routine blood tests, sa
tisfactory chest X-ray and ECG and full mobility. Results: The clinical cha
racteristics were identical in the two groups. The number of grafts per pat
ient was 2.8 +/- 0.8 and 3.2 +/- 1.0, and the total ischaemic time 47 +/- 1
3 and 46 +/- 14 min in the normal and early discharge groups, respectively
(P = NS in each instance). In the normal discharge group the mean hospital
stay was 7.7 +/- 3.3 days whereas in the early discharge group it was 4.7 /- 2.0 days (P < 0.0001) with 73.5% of the patients being discharged within
the first 4 days following surgery. The shortening of hospital stay result
ed in a mean reduction of costs of pound 750/patient. There was no operativ
e mortality (<30 days following surgery) and the incidence of non-fatal per
ioperative complications were similar in the two groups, with the exception
that the incidence of supraventricular arrhythmias was significantly highe
r in the normal discharge group than in the early discharge group (33% vs.
6.3% respectively; P < 0.0001). These rhythm abnormalities occurred within
the first 4 days in 89% of patients following surgery and were the cause of
readmission in only one patient in the normal discharge group. There were
a total of ten (8.4%) readmissions in the normal discharge group and three
(3.8%) in the early discharge group. Conclusion: Shortening the postoperati
ve hospital stay to 4 days following elective coronary bypass surgery appea
rs to be safe and can be a means of reducing the cost of care. This in turn
may result in a greater availability of resources and in an effective way
of reducing waiting Lists. (C) 2000 Elsevier Science B.V. All rights reserv
ed.