Background. A new emphasis has been directed toward ''off-pump'' coron
ary artery bypass grafting to avoid the morbidity of cardiopulmonary b
ypass and further reduce the postoperative hospital length of stay. Wi
th the intent of achieving a hospital discharge for ''on-pump'' corona
ry artery bypass grafting procedures comparable with the same procedur
es ''off pump,'' we applied a rapid-recovery protocol with particular
attention paid to patients eligible for discharge on the third postope
rative day. Methods. The cases of 104 consecutive patients who underwe
nt isolated coronary artery bypass grafting using cardiopulmonary bypa
ss were retrospectively reviewed. A rapid-recovery protocol emphasizin
g reduced cardiopulmonary bypass time, an anesthesia protocol for earl
y extubation, perioperative administration of corticosteroids and thyr
oid hormone, and aggressive diuresis was applied to all patients. The
goal during the first 24 hours postoperatively was to achieve early ex
tubation as well as a mild state of negative fluid balance and to ensu
re absence of postoperative bleeding and a safe transfer from the inte
nsive care unit to a monitored floor. On the second postoperative day,
chest drains were discontinued, and aggressive ambulation therapy was
instituted. If at 72 hours postoperatively the patient was walking wi
thout assistance, had return of normal bowel function, and had no atri
al fibrillation, a 3-day discharge home was planned. Results. The 30-d
ay mortality rate for the entire group was 1.9%. The average postopera
tive hospital length of stay for the entire series was 4.8 +/- 2.4 day
s. Of the 102 survivors, 30 patients (29%) were discharged within 3 da
ys postoperatively (group 1), and 72 patients (71%) were discharged af
ter the third postoperative day (group 2). Patients in group 1 were yo
unger and had fewer comorbid conditions. Compared with group 2, group
1 had fewer patients with diabetes (7% versus 28%; p < 0.05), congesti
ve heart failure (7% versus 18%), symptomatic vascular disease (0% ver
sus 11%), chronic obstructive pulmonary disease (0% versus 10%), ambul
atory difficulties (0% versus 10%), and the requirement of an intraaor
tic balloon pump preoperatively (13% versus 35%). Group 1 patients als
o had almost no complications and a lower readmission rate (3.3% versu
s 6.9%). Conclusions. With the application of a rapid-recovery protoco
l to patients undergoing ''on-pump'' coronary artery bypass grafting,
discharge home within 3 days postoperatively is attainable and safe fo
r patients who have minimal comorbid conditions. (C) 1997 by The Socie
ty of Thoracic Surgeons.