Early discharge following coronary bypass surgery: is it safe?

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.