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(Circulation. 1995;92:20-24.)
© 1995 American Heart Association, Inc.

Articles

Determinants of Length of Stay After Coronary Artery Bypass Graft Surgery

Presented at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14 to 17, 1994.

Harold L. Lazar, MD; Carmel Fitzgerald, RN; Stacy Gross, RN; Tim Heeren, PhD; Gabriel S. Aldea, MD; Richard J. Shemin, MD

From the Department of Cardiothoracic Surgery, The Boston University Medical Center, Boston, Mass.

Correspondence to Harold L. Lazar, MD, Department of Cardiothoracic Surgery, The Boston University Hospital, 88 E Newton St, B402, Boston, MA 02118.

Background Rising healthcare costs have prompted limitations in the length of stay (LOS) for patients undergoing coronary artery bypass graft surgery (CABG). Because not all patients are candidates for early discharge, in the present study our aim was to determine factors that prolong LOS.

Methods and Results In 194 consecutive patients undergoing CABG procedures, LOS was >7 days in 37%. Stepwise multiple regression procedures and ² testing were used to determine what factors prolonged LOS for >7 days. Preoperative factors that significantly (P<.05) prolonged LOS included repeat CABG, CABG plus valve surgery, congestive heart failure, preoperative coronary care unit stay, renal failure, and insulin-dependent diabetes mellitus. Patients with at least one risk factor had a significantly higher incidence of LOS of >7 days (47% versus 17%; P<.001). Significant (P<.05) postoperative factors prolonging LOS included arrhythmias, respiratory insufficiency, pneumonia, and wound infection. Of patients with at least one risk factor, 83% had LOS of >7 days (P<.001).

Conclusions The presence of certain preoperative and postoperative risk factors can be predicted to prolong LOS after CABG surgery. This should be taken into consideration when defining reimbursement policies.

Key Words: bypass • surgery • risk factors

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