Association of expedited discharge with outcomes following isolated coronary artery bypass grafting

BACKGROUND: Despite the introduction of enhanced recovery after surgery pathways, the duration of hospital stay for cardiac operations has not considerably declined. In the present work, we evaluated the association of expedited discharge with a marker of resource use in a national cohort. METHODS: All elective (≥18 years) hospitalizations for isolated coronary artery bypass grafting were tabulated from the 2016-2022 Nationwide Readmissions Database utilizing relevant International Classification of Diseases, 10th Revision codes. Patients were stratified into expedited (≤4 days) or routine (>4 days) discharge based on the median length of stay on exploratory analysis. Mixed regression models were developed to identify the association of expedited discharge with hospitalization costs, length of stay, and 30-day readmissions. RESULTS: Of an estimated 511,472 patients undergoing isolated coronary artery bypass grafting, 42.2% experienced expedited discharge. Compared with others, expedited patients were younger (64 years [interquartile range, 58-70] vs 66 years [interquartile range, 60-77], P < .001), less frequently female (14.9 vs 20.2%, P < .001), and more frequently privately insured (43.4 vs 34.7%, P < .001). Following risk adjustment, expedited status was linked with reduced length of stay (β = -1.83 days; 95% confidence interval, -1.85 to -1.82), hospitalization costs (β = -7,160; 95% confidence interval, -7,280 to -7,050), and 30-day readmissions (adjusted odds ratio, 0.70; 95% confidence interval, 0.67-0.62). Upon further analysis, expedited discharge status was associated with greater freedom from readmission, yet there was significant variation in discharge timing. CONCLUSION: Expedited discharge following isolated coronary artery bypass grafting is associated with reduced hospitalization costs, shorter length of stay, and decreased readmission rates, without increased mortality or major complications. These findings support the consideration of safe and cost-effective implementation of recovery protocols in appropriately selected patients.