Identifying Selected Mental Health, Physical, and Social Determinants of Extended Length of Stay After Elective Cardiac Surgery

OBJECTIVE: Cardiovascular disease is the second leading cause of death among Canadians, with approximately 40 000 open-heart surgeries such as coronary artery bypass grafting (CABG) and valve replacements performed annually. The best practices after cardiac surgery include a hospital stay of 4 to 7 days to facilitate safe discharge. We explored associations between an extended length of stay and selected mental, physical, and social determinants of health routinely collected before surgery, with the aim of informing the development of a future prescreening instrument to better identify patients at risk for prolonged recovery times. METHODS: A single-center longitudinal retrospective chart review was conducted at Trillium Health Partners, a large urban center in Canada. A list of 250 randomized charts, half with regular length of stay (LOS) (≤4 days) and half with extended LOS (>4 days), indicating those who underwent elective cardiac surgery between November 2021 and August 2023 was analyzed. Demographic, clinical, mental, physical, and social variables were examined to identify their associations with extended LOS. RESULTS: The study included 250 patients with a median age of 65 years (±12 years), 80% male, and 84% undergoing CABG. Factors associated with an extended LOS included cardiac surgeries other than CABG alone ( P = .002), female sex ( P = .038), left ventricular function >1 ( P = .024), need for postoperative homecare ( P = .028), and absence of a specialized medical home support program for patients' postcardiac surgery ( P = .017). CONCLUSIONS: The current in-hospital pathway of 4 days at our center may not be applicable to all patients undergoing elective cardiac surgery. These findings highlight the importance of considering sex, left ventricular function, need for homecare after surgery, and lack of specialized medical home support programs in preoperative screening and planning to improve resource allocation and patient outcomes.