title: Increasing healthcare resource utilization after coronary artery bypass graft surgery in the United States.
abstract: BACKGROUND
  Despite declining lengths of stay, postdischarge healthcare resource utilization may be increasing because of shifts to nonacute care settings. Although changes in hospital stay after coronary artery bypass graft (CABG) surgery have been described, patterns of discharge remain unclear. Our objective was to determine patterns of discharge disposition after CABG surgery in the United States.
  
  
  RESULTS
  We examined discharge disposition after CABG procedures from 1988 to 2005 using the Nationwide Inpatient Sample. Discharges with a "nonroutine" disposition defined patients discharged with continued healthcare needs. Multivariable regression models were constructed to assess trends and factors associated with nonroutine discharge. Median length of stay among 8,398,554 discharges decreased from 11 to 8 days between 1988 and 2005 (P<0.0001). There was a simultaneous increase in nonroutine discharges from 12% in 1988 to 45% in 2005 (P<0.0001), primarily comprising home healthcare and long-term facility use. Multivariable regression models showed age, female gender, comorbidities, concurrent valve surgery, and lower-volume hospitals more likely to be associated with nonroutine discharge.
  
  
  CONCLUSIONS
  We found a significant increase in nonroutine discharges after CABG surgery across the United States from 1988 to 2005. The significant shortening of length of stay during CABG may be counterbalanced by the increased requirement for additional postoperative healthcare services. Nonacute care institutions are playing an increasingly significant role in providing CABG patients with postdischarge healthcare and should be considered in investigations of postoperative healthcare resource utilization. The impact of these changes on long-term outcomes and net resource utilization remain unknown.
authors.affiliation: Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. swami001@mc.duke.edu
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Phillips-Bute
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: Laura E
authors.initials: LE
authors.lastname: Archer
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mathew
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006699:Home Care Services / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology