Surgical versus medical care for postoperative cardiac surgical patients at the general ward.
OBJECTIVE
To shorten hospital stay after cardiac surgery, several risk factors have been defined to identify patients who can be discharged early. These risk factors are dependant on the patient; no studies exist on the influence of the treating physician himself on postoperative patient stay.


METHODS
In a university affiliated cardiac surgical clinic we investigated patients who were postoperatively treated either on medical wards with no cardiac surgeon's presence or on a cardiac surgical ward; at both types of wards physicians had several years experience with cardiac surgical patients. Taking several risk factors for postoperative morbidity into account, postoperative length of stay and incidence of wound healing complications have been compared.


RESULTS
Within a 3-month period, 84 patients were treated at the cardiac surgical ward, 102 patients at the medical wards. Risk factors for postoperative morbidity were present in 87% of patients, statistically independent of postoperative wards. Although demographic data and median ICU-stay of both patient groups was comparable, the median post-ICU stay was 9 days at the surgical and 13 days at the medical wards (P < 0.0001). Incidence of wound healing complication was higher (19.6%) at the medical wards than at the surgical ward (10.7%), without reaching statistical significance.


CONCLUSIONS
As patients at the respective wards were statistically not different, the difference in post-ICU stay, infection and costs must depend on the treating physicians. As a consequence, postoperative care for cardiac surgical patients in all cases should include direct cardiac surgical participation.
Gödje
O
O
Department of Cardiac Surgery of the Ludwig-Maximilians-University of Munich at Augustinum, Germany. oliver.goedje@medizin.uni-ulm.de
Lamm
P
P
Adelhard
K
K
Schütz
A
A
Kilger
E
E
Götz
A
A
Lange
T
T
Mair
H
H
Reichart
B
B
D000368:Aged; D006348:Cardiac Surgical Procedures; D002983:Clinical Competence; D003325:Coronary Care Units; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D000078329:Workforce