Reasons for prolonged hospital stays following heart surgery.

Improvements in cardiac surgery techniques and after care have resulted in a reduction in postoperative stay. Ten years ago the average length of stay following surgery was 13-15 days (Sanchez et al, 1994). Today it is more likely to be 4-7 days (Bemat, 1997). A recent audit provided information on postoperative hospitalization in a cardiac population that was deemed suitable for immediate high dependency care rather than intensive care. The authors carried out retrospective examination of patients' notes in order to detect the possible causes for delayed discharge. The audit was conducted over a 3-month period and information was collected on 210 postoperative cardiac patients. The study population was restricted to all cardiac patients transferred directly to the hospital's 'overnight intensive recovery' unit. These patients are regarded as low- to medium-risk cardiac patients. Thirty seven per cent of the study population experienced a prolonged hospital stay, i.e. greater than 7 days. In the majority of cases the reasons for delayed discharge were non-cardiac in origin. The authors reviewed the literature to identify strategies that may reduce the incidence of preventable complications leading to prolonged hospitalization. They concluded that nurses have a fundamental role to play in reducing the incidence and severity of postoperative complications through patient education, motivation and early identification of potential problems.