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EARLY DISCHARGE AFTER CABG CAN BE SAFE.

Is the push for shortened length-of-stay after coronary artery bypass grafting (CABG) increasing readmission and mortality rates? This study analyzed length-of-stay and outcomes data for 83,347 non-HMO Medicare patients who were discharged within 14 days of CABG in 1992.

Medical claims and Medicare enrollment data indicated that one percent of these patients died within 60 days, and another 18 percent were readmitted to an acute care facility. Just over half of readmissions were for cardiovascular disease. Overall, 6 percent of patients were initially discharged within five days of the operation; these patients were less likely to have been admitted for an acute MI and tended to be younger, male, and have fewer comorbid illnesses. Early discharge rates varied among states from 1 to 21 percent. Multivariate analysis showed lower rates of death and cardiovascular readmission in patients who were discharged early (5 vs. 12 percent for patients discharged at days 5 and 14, respectively).

Comment: These data indicate that, at least in 1992, physicians appeared able to identify elderly patients who could safely be discharged early. As financial pressures mount and the percentage of early discharges rises, this issue will need to be revisited.

— TH Lee

Published in Journal Watch General Medicine October 10, 1997

Citation(s):

Cowper PA et al. Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death. J Am Coll Cardiol 1997 Oct 30 908-913.

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