Son Andre Y, Karim Azad S, Fiehler Monica, Andrei Adin-Cristian, Vassallo Patricia, Churyla Andrei, Pham Duc Thinh, McCarthy Patrick M, Chris Malaisrie S
Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Illinois, USA.
Division of Biostatistics, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Illinois, USA.
J Card Surg. 2021 Apr;36(4):1441-1447. doi: 10.1111/jocs.15404. Epub 2021 Feb 10.
Shorter length of stay (LOS) is a welcome consequence of optimized perioperative care. However, accelerated hospital discharge may have unintended consequences. Before implementing an institutional enhanced recovery after surgery protocol, we evaluated the safety of shorter LOS and compared outcomes of patients with shorter LOS (LOS ≤ 3 days) to those with longer LOS (LOS > 3 days).
We identified all patients undergoing elective cardiac surgery with cardiopulmonary bypass between July 2004 and June 2017. Transcatheter approaches, ventricular assist devices, transplants, and traumas were excluded. Patients were divided into two cohorts, one with shorter hospitalizations (LOS ≤ 3 days) and one with longer hospitalizations (LOS > 3 days). Propensity score matching (PSM) was performed and differences between the two groups were compared.
A total of 5,987 patients (63.0 ± 13.8 years old, 34% female) were identified and 131 (2.2%) patients were LOS ≤ 3 days; median STS Risk score was 1.2 (0.6-2.4). PSM resulted in a total of 478 patients (357 LOS > 3 and 121 LOS ≤ 3 days); median STS Risk score was 0.4 (0.3-0.9). LOS ≤ 3 days had lower rates of postoperative atrial fibrillation (2% vs. 19%; p < .001) and major in-hospital complications (0% vs. 9%; p = .001); however, 30-day readmissions (8% LOS ≤ 3 vs. 6% LOS > 3 days; p = .66) and mortality rates (0% vs. 0%) were comparable between the two groups.
LOS ≤ 3 days was associated with less postoperative atrial fibrillation and fewer major in-hospital complications. LOS ≤ 3 days was not associated with rehospitalization or mortality. Shorter LOS after elective cardiac surgery appears to be a safe practice with favorable outcomes, especially in low operative risk patients.
缩短住院时间（LOS）是围手术期优化护理带来的一个令人满意的结果。然而，加速出院可能会产生意想不到的后果。在实施一项机构性的术后加速康复方案之前，我们评估了缩短住院时间的安全性，并将住院时间较短（LOS≤3天）的患者与住院时间较长（LOS>3天）的患者的结局进行了比较。
我们确定了2004年7月至2017年6月期间所有接受体外循环心脏直视手术的患者。经导管治疗方法、心室辅助装置、移植手术和创伤患者被排除在外。患者被分为两个队列，一个是住院时间较短（LOS≤3天）的队列，另一个是住院时间较长（LOS>3天）的队列。进行了倾向评分匹配（PSM），并比较了两组之间的差异。
共确定了5987例患者（年龄63.0±13.8岁，34%为女性），其中131例（2.2%）患者LOS≤3天；中位胸外科医师协会（STS）风险评分为1.2（0.6-2.4）。PSM后共有478例患者（357例LOS>3天，121例LOS≤3天）；中位STS风险评分为0.4（0.3-0.9）。LOS≤3天的患者术后房颤发生率较低（2%对19%；p<0.001），住院期间主要并发症发生率也较低（0%对9%；p=0.001）；然而，两组之间30天再入院率（LOS≤3天为8%对LOS>3天为6%；p=0.66）和死亡率（0%对0%）相当。
LOS≤3天与较少的术后房颤和较少的住院期间主要并发症相关。LOS≤3天与再住院或死亡率无关。择期心脏手术后较短的住院时间似乎是一种安全的做法，具有良好的结局，尤其是在手术风险较低的患者中。
