title: Relocation of patients after cardiac surgery: is it worth the effort?
abstract: BACKGROUND
  Fast-track protocols may facilitate early patient discharge from the site of surgery through the implementation of more expedient pathways. However, costs may merely be shifted towards other parts of the health care system. We aimed to investigate the consequence of patient transfers on overall hospitalisation, follow-up and readmission rate after cardiac surgery.
  
  
  METHODS
  A single-centre descriptive cohort study using prospectively entered registry data. The study included 4,515 patients who underwent cardiac surgery at Aarhus University Hospital during the period 1 April 2006 to 31 December 2012. Patients were grouped and analysed based on type of discharge: Directly from site of surgery or after transfer to a regional hospital. The cohort was obtained from the Western Denmark Heart Registry and matched to the Danish National Hospital Register.
  
  
  RESULTS
  Median overall length of stay was 9 days (7.0;14.4). Transferred patients had longer length of stay, median difference of 2.0 days, p < 0.001. Time to first outpatient consultation was 41(30;58) days in transferred patients vs. 45(29;74) days, p < 0.001. 18.6% was readmitted within 30 days. Mean time to readmission was 18.4 ± 6.4 days. Median length of readmission was 3(1,6) days. There was no difference in readmissions between groups. Leading cause of readmission was cardiovascular disease with 48%.
  
  
  CONCLUSIONS
  Transfer of patients does not overtly reduce health care costs, but overall LOS and time to first outpatient consultation are substantially longer in patients transferred to secondary hospitals than in patients discharged directly. Readmission rate is high during the month after surgery, but with no difference between groups.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.|Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: L S
authors.initials: LS
authors.lastname: Hansen
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: V E
authors.initials: VE
authors.lastname: Hjortdal
authors.affiliation: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Jakobsen
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010360:Patient Transfer; D011446:Prospective Studies; D012017:Referral and Consultation