TY - JOUR
T1 - Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death
AU - Cowper, Patricia A.
AU - Peterson, Eric D.
AU - DeLong, Elizabeth R.
AU - Jollis, James G.
AU - Muhlbaier, Lawrence H.
AU - Mark, Daniel B.
N1 - Funding Information:
This study was supported by Research Grants HS-06503 and HS-08805-02 from the Agency for Health Care Policy and Research, Rockville, Maryland and was presented in part at the 45th Annual Scientific Session of the American College of Cardiology, Orlando, Florida, March 1996.
PY - 1997/10
Y1 - 1997/10
N2 - Objectives: This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992. Background: Protocols that encourage earlier discharge of patients who have had CABG have been implemented across the country. Although delivery of efficient care benefits both patients and providers, premature discharge can adversely affect clinical outcomes, resulting in increased hospital readmissions and higher long-term costs. Methods: We examined the prevalence of early discharge (postoperative length of stay ≤5 days) among 83,347 non-health maintenance organization (HMO) Medicare patients who underwent CABG in the United States in 1992. Using logistic regression models, we identified patient characteristics associated with early discharge and obtained risk- adjusted rates of death and readmission or death for postoperative lengths of stay between 4 and 14 days. Results: In 1992, 6% of Medicare patients undergoing CABG were discharged within 5 days of the operation. The prevalence of early discharge varied considerably among states, ranging from 1% to 21%. Patients discharged early tended to be younger and male and have fewer comorbid illnesses. Risk-adjusted rates of death and death or cardiovascular readmission were lowest among patients discharged early. Conclusions: As of 1992, early discharge of elderly patients treated with CABG in non-HMO settings was not associated with higher 60-day rates of death or readmission. This suggests that physicians were able to identify low risk candidates for early discharge. Variation across the nation in early discharge rates, along with the percentage of patients without major risk factors for adverse outcomes, suggests that higher rates of early discharge might be safely achieved.
AB - Objectives: This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992. Background: Protocols that encourage earlier discharge of patients who have had CABG have been implemented across the country. Although delivery of efficient care benefits both patients and providers, premature discharge can adversely affect clinical outcomes, resulting in increased hospital readmissions and higher long-term costs. Methods: We examined the prevalence of early discharge (postoperative length of stay ≤5 days) among 83,347 non-health maintenance organization (HMO) Medicare patients who underwent CABG in the United States in 1992. Using logistic regression models, we identified patient characteristics associated with early discharge and obtained risk- adjusted rates of death and readmission or death for postoperative lengths of stay between 4 and 14 days. Results: In 1992, 6% of Medicare patients undergoing CABG were discharged within 5 days of the operation. The prevalence of early discharge varied considerably among states, ranging from 1% to 21%. Patients discharged early tended to be younger and male and have fewer comorbid illnesses. Risk-adjusted rates of death and death or cardiovascular readmission were lowest among patients discharged early. Conclusions: As of 1992, early discharge of elderly patients treated with CABG in non-HMO settings was not associated with higher 60-day rates of death or readmission. This suggests that physicians were able to identify low risk candidates for early discharge. Variation across the nation in early discharge rates, along with the percentage of patients without major risk factors for adverse outcomes, suggests that higher rates of early discharge might be safely achieved.
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U2 - 10.1016/S0735-1097(97)00243-X
DO - 10.1016/S0735-1097(97)00243-X
M3 - Article
C2 - 9316517
AN - SCOPUS:0030854121
SN - 0735-1097
VL - 30
SP - 908
EP - 913
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -