Key result
Expedited discharge after isolated CABG was associated with reduced odds of 30-day nonelective readmission compared to routine discharge (4.6% vs 7.3%; AOR 0.78; 95% CI 0.71-0.85).
Why the study?
Expedited discharge after CABG has been postulated as a solution for reducing hospitalization costs, but its impact on readmissions and costs required evaluation.
Does expedited discharge reduce readmissions and costs in adults undergoing isolated CABG without perioperative complications?
Cohort (n=187,591)
Yes
Does expedited discharge reduce readmissions and costs in adults undergoing isolated CABG without perioperative complications?
Odds Ratio: 0.78 (95% CI 0.71–0.85)
Absolute Event Rate: 4.6% vs 7.3%
p-value: p=<0.001
Expedited discharge (≤4 days) after uncomplicated isolated CABG is associated with lower index hospitalization costs and reduced 30- and 90-day nonelective readmissions.
Expedited discharge may lower costs without raising readmissions after CABG; leaves open need for randomized trials before practice change.
OBJECTIVES: Expedited discharge after coronary artery bypass grafting (CABG) has been postulated as a possible solution for reducing hospitalization costs. This study aimed to evaluate the impact of expedited postoperative discharge on readmissions and costs in patients undergoing isolated CABG. DESIGN: Adults (≥18 years) who underwent isolated CABG were identified using the 2016-to-2019 Nationwide Readmission Database. Patients were classified as expedited or routine, with expedited patients being discharged on or before postoperative day 4. Those who experienced perioperative complications were excluded. SETTING: The Nationwide Readmissions Database. PARTICIPANTS: Patients ≥18 years old who underwent isolated CABG. MEASUREMENTS AND MAIN RESULTS: Of an estimated 187,591 patients meeting study criteria, 37.2% (n = 69,861) experienced expedited discharge. Expedited patients experienced lower index hospitalization costs ($28,543 v $34,114, p < 0.001), and were less likely to experience 30-day nonelective readmission (4.6% v 7.3%, p < 0.001) and 90-day nonelective readmission (5.6% v 8.7%, p < 0.001). After adjustment, expedited discharge remained independently associated with reduced odds of both 30-day (adjusted odds ratio [AOR]: 0.78, 95% CI: 0.71-0.85) and 90-day (AOR: 0.80, 95% CI: 0.74-0.87) nonelective readmission. In addition, expedited discharge was associated with an incremental decrease in index hospitalization costs (β: -5,661, 95% CI: -5,894 to -5,429). CONCLUSIONS: Expedited discharge immensely decreases costs of care for patients undergoing isolated CABG, as well as readmission risks. Expedited discharge may be considered a strategy to both improve postoperative patient care and reduce hospitalization costs within the United States healthcare system.
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Williamson et al. (2022) conducted a cohort in Isolated coronary artery bypass grafting (CABG) (n=187,591). Expedited discharge (≤4 days postoperatively) vs. Routine discharge was evaluated on 30-day nonelective readmission (AOR 0.78, 95% CI 0.71-0.85, p=<0.001). Expedited discharge after isolated CABG was associated with reduced odds of 30-day nonelective readmission compared to routine discharge (4.6% vs 7.3%; AOR 0.78; 95% CI 0.71-0.85).
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