Is early too early? Effect of shorter stays after bypass surgery.
BACKGROUND
Postoperative stays after coronary artery bypass graft surgery (CABG) decreased substantially in the 1990s. Although shorter stays offer clinical benefits, premature discharge could increase adverse events and offset initial savings. This study examined the effect of early discharge after CABG on readmission/death and cost within 60 days of discharge home. Variability in hospitals' tendencies for early discharge and adverse outcomes was also explored.


METHODS
Analyses were based on clinical and claims data for 55,889 New York CABG patients discharged home 1995 to 1998. Early discharge was defined as a postoperative stay below the 15th percentile for patients with similar risk. The likelihood of early discharge and its effect on readmission/death were examined using hierarchical logistic regression, accounting for patient risk and within-hospital correlation. The correlation between early discharge and adverse outcomes at the hospital level was assessed. The effect of early discharge on subsequent inpatient, outpatient, skilled nursing, and home health costs was examined in the Medicare subset.


RESULTS
Overall, 17% of patients were discharged early, with increasing prevalence over time. The tendency to discharge early varied widely among hospitals (2% to 42% of patients). We found no association between hospitals' tendencies for early discharge and adverse outcomes. Lower postdischarge costs among patients discharged early (mean = 3,491 dollars versus 5,246 dollars for typical stays) resulted in average cumulative savings of 6,309 dollars.


CONCLUSIONS
Patients selected for earlier discharge after CABG did not have increased adverse event rates or higher costs. Variation among hospitals in early discharge suggests that more efficient patient management could be achieved at some hospitals.
Cowper
Patricia A
PA
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA. cowpe001@mc.duke.edu
DeLong
Elizabeth R
ER
Hannan
Edward L
EL
Muhlbaier
Lawrence H
LH
Lytle
Barbara L
BL
Jones
Robert H
RH
Holman
William L
WL
Pokorny
Janel J
JJ
Stafford
Judith A
JA
Mark
Daniel B
DB
Peterson
Eric D
ED
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011182:Postoperative Care