Shorter Stay Does Not Increase Risk After Open-Heart Surgery

S. Chris Malaisrie, MD

A new study from the 56th Annual Meeting of The Society of Thoracic Surgeons (STS) found patients undergoing open-heart surgery could have shorter in-hospital recovery times than previously reported.

Results of the study, presented by S. Chris Malaisrie, MD, cardiac surgeon with Northwestern Medicine in Chicago, revealed patients who have undergone open-heart surgery can leave the hospital 3 days after surgery without an increased risk of complications.

"We have shown that long hospital stays after heart surgery are no longer necessary, and patients can go home safely after just a few days in the hospital," said Malaisrie, in a release from the STS. ”This information helps pave the way for the introduction of a cardiac enhanced recovery after surgery (ERAS) program, proving that the use of such a strategy is feasible."

To evaluate the safety of shorter lengths of stay following open-heart surgeries, investigators conducted a review of elective cardiac surgeries with cardiopulmonary bypass between July 2004 and June 2017 at Northwestern Memorial Hospital. From their search, Malaisrie and colleagues identified 2 cohorts of propensity score-matched patients—including 121 patients with a length of stay of 3 days or fewer, and 357 with a length of stay greater than 3 days.

Upon analysis, characteristics and outcomes, including rates of other obligations, 30-day readmissions, and mortality rates were comparable between the 2 arms of the study. The incidence of postoperative atrial fibrillation was notably higher among patients with a length of stay exceeding 3 days (2% vs 19%).

Based on the results of their study and previous studies of similar design, Malaisrie and colleagues at Northwestern Medicine anticipate implementing the first cardiac ERAS program, which is designed to offer standardized approaches for optimizing surgical outcomes.

According to a release from Northwestern, the program is expected to increase recovery time, reduce complications, reduce length of stay, and improve patients satisfaction. The same release also went on to mention plans for future studies examining clinical endpoints and patient-reported outcomes as a result of the aforementioned program.

"Expectations for recovery after cardiac surgery are being reset in the current era," Malaisrie said. "What does this mean for patients? It means that prolonged or taxing recovery is no longer required. Patients should know that recovery from heart surgery is not only quicker, but also better with ERAS programs."

This study, “Early Discharge is Not Associated with Worse Outcome and Re-Admission: A Preview of Enhanced Recovery After Cardiac Surgery,” was presented at the 56th Annual Meeting Annual Meeting of the STS.