title: [Morbidity and hospital cost reduction in cardiac surgery using a presurgery ambulatory strategy].
abstract: In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience.
  
  
  OBJECTIVE
  1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital.
  
  
  METHODS
  We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification.
  
  
  METHODS
  Student t test was conduncted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p <0.05 to be statistically significant.
  
  
  RESULTS
  In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001).
  
  
  CONCLUSIONS
  The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission an operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.
authors.affiliation: Departamento de Ecocardiografía. Instituto Nacional de Cardiología Ignacio Chávez.
authors.forename: Nydia
authors.initials: N
authors.lastname: Ávila-Vanzzini
authors.forename: Jorge
authors.initials: J
authors.lastname: Kuri-Alfaro
authors.forename: Laura Leticia
authors.initials: LL
authors.lastname: Rodríguez-Chávez
authors.forename: Gabriela
authors.initials: G
authors.lastname: Meléndez-Ramírez
authors.forename: Sergio
authors.initials: S
authors.lastname: Trevethan-Cravioto
authors.forename: Alejandro
authors.initials: A
authors.lastname: Quiroz-Martínez
authors.forename: Héctor
authors.initials: H
authors.lastname: Herrera-Bello
authors.forename: Valentín
authors.initials: V
authors.lastname: Herrera-Alarcón
authors.forename: Humberto
authors.initials: H
authors.lastname: Martínez-Hernández
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Martínez-Ríos
mesh_terms: D000553:Ambulatory Care; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D057234:Preoperative Period; D014850:Waiting Lists