Nav: Home

Discharge 3 days following open heart surgery is safe

January 27, 2020

NEW ORLEANS, Louisiana (January 27, 2020) -- Patients who undergo open heart surgery and head home 3 days later are not at increased risk for complications, according to a scientific presentation at the 56th Annual Meeting of The Society of Thoracic Surgeons.

"We have shown that long hospital stays after heart surgery are no longer necessary, and patients can go home safely after just a few days in the hospital," said S. Chris Malaisrie, MD, from Northwestern Medicine in Chicago. "This information helps pave the way for the introduction of a cardiac enhanced recovery after surgery (ERAS) program, proving that the use of such a strategy is feasible."

Dr. Malaisrie and colleagues identified patients who underwent nonemergency coronary artery bypass grafting (CABG) surgery and valve surgery between July 2004 and June 2017 at Northwestern Memorial Hospital. Researchers examined data from 478 patients. The patients were separated into two groups: 357 patients with a length of stay (LOS) greater than 3 days and 121 patients with a LOS less than 3 days. Aside from postoperative atrial fibrillation rates (2% in the ?3 day LOS group and 19% in the >3 day LOS group), rates of other complications, 30-day readmissions, and mortality rates were comparable.

"Patients can go home after a shorter length of stay in the hospital without increased risk of complications and rehospitalizations," said Dr. Malaisrie. "Because we found no detrimental effect of accelerated discharge, both patients and physicians should not be averse to discharging patients when medically ready."

ERAS--pronounced E-ras--is a multidisciplinary treatment program designed to achieve quicker recovery for patients undergoing major surgery and offers sustainable improvement in the overall quality of care. First popularized in Denmark in the 1990s, it since has become more accepted. Over the past several years, ERAS programs have been incorporated into many surgical specialties, with general thoracic surgery recently joining the movement and heart surgery following soon after. Research has shown that in other surgical fields that have adopted ERAS, hospital stays have shortened by 30% to 50%, while readmission rates and costs also decreased.

According to Dr. Malaisrie, this recent study prompted his colleagues to develop Northwestern's first cardiac ERAS program, which will offer standardized approaches for optimizing surgical outcomes. The program--still in development--will include a suite of modern care protocols based on the recently published guidelines from the ERAS Cardiac Society for optimal, evidence-based perioperative care in heart surgery.

"For many years, high-performing institutions have been able to promote safe early recovery from complex cardiac surgical procedures," said Daniel T. Engelman, MD, from Baystate Medical Center in Massachusetts and president of the ERAS Cardiac Society, who was not directly involved with this study. "It has been shown in the statewide Michigan collaborative that more than 80% of preventable morbidity and mortality following cardiac surgery occurs outside of the operating room. It is now up to all of us to standardize evidence-based best practices in the recovery phase--to not just speed up discharge, but also to improve the patient-centered experience. In addition, this will necessitate better preoperative counseling to guide realistic expectations supporting multimodal pain control, postoperative mobility, and family support, ensuring complete physical and psychological recovery from the stress of surgery."

The published recommendations describe 22 potential interventions, separated into sections that cover all phases of surgical care--preoperative, intraoperative, and postoperative--and each principle is graded according to strength and level of evidence. Some of the recommendations include the cessation of drinking alcohol and smoking, avoidance of prolonged fasting, the concept of "prehabilitation" (exercise training, nutrition optimization, and anxiety reduction), strategies for reducing opioid use and dependence after surgery, and the use of urinary biomarkers to identify patients at increased risk for acute kidney injury. The guidelines are meant to be flexible and individually tailored for each program.

"Multiple interventions are required for the success of an ERAS program," said Dr. Malaisrie. "There is no single magic bullet. Instead, it is through cumulative efforts that ERAS is successful for the patient. We would like to see the care of heart surgery patients be focused more on improving outcomes from the patient's perspective and less from the physician's."

Dr. Malaisrie anticipates that the Northwestern Medicine cardiac ERAS program will result in faster recoveries, reduced complications, decreased time in the hospital, lower costs, and improved patient/family satisfaction. In the future, the researchers plan to closely examine both traditional clinical endpoints and patient-reported outcomes from the program.

"Expectations for recovery after cardiac surgery are being reset in the current era," he said. "What does this mean for patients? It means that prolonged or taxing recovery is no longer required. Patients should know that recovery from heart surgery is not only quicker, but also better with ERAS programs."
-end-
The other authors of the study were AY Son, PM McCarthy, M Fiehler, A Chadha, M Liu, A Andrei, J Nakano, A Churyla, and D Pham.

Dr. Engelman was the lead author of the "Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations" published in JAMA Surgery.

Find comprehensive medical information presented for patients by leading experts in cardiothoracic surgery on the STS Patient Website (ctsurgerypatients.org). For more information, contact Senior Media Relations Manager Jennifer Bagley at 312-202-5865 or jbagley@sts.org.

Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,500 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society's mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

The Society of Thoracic Surgeons

Related Heart Surgery Articles:

New heart valve could transform open heart surgery for millions of patients globally
A new polymeric heart valve with a life span potentially longer than current artificial valves that would also prevent the need for the millions of patients with diseased heart valves to require life-long blood thinning tablets has been developed by scientists at the universities of Bristol and Cambridge.
Heart surgery stalled as COVID-19 spread
In two recent journal articles, Dr. Marc Ruel explores how hospitals worldwide scaled back on heart surgeries as the pandemic hit, and how they can resume those operations in a world still plagued by the SARS-CoV-2 virus.
Discharge 3 days following open heart surgery is safe
Patients who undergo open heart surgery and head home 3 days later are not at increased risk for complications.
Obesity surgery improves the heart
The benefits of bariatric surgery for obese individuals go beyond weight loss, according to a study presented today at EuroEcho 2019, a scientific congress of the European Society of Cardiology (ESC).
Melatonin may not help prevent delirium after heart surgery
Delirium is observed in approximately 15% of hospitalised older adults, and it is more common in the critically ill and in those undergoing major surgery, such as heart surgery.
Study debunks 'July Effect' for heart surgery
The notion that more medical errors occur in July compared to other months due to an influx of new medical school graduates starting their in-hospital training does not apply to heart surgery, according to research in The Annals of Thoracic Surgery, published by Elsevier.
Brain health not affected by major heart surgery
Patients who undergo heart surgery do not experience major memory changes--either better or worse--when compared with those who have a much less invasive, catheter-based procedure, according to a study published online today in The Annals of Thoracic Surgery.
Does open heart surgery affect cognitive abilities?
Understanding how heart valve surgery may affect your cognition is important for older adults.
I have had a heart attack. Do I need open heart surgery or a stent?
New advice on the choice between open heart surgery and inserting a stent via a catheter after a heart attack is launched today.
Antipsychotic use in older adults after heart surgery
In a new study published in the Journal of the American Geriatrics Society, researchers looked into the use of antipsychotic medications in older adults following heart surgery.
More Heart Surgery News and Heart Surgery Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Warped Reality
False information on the internet makes it harder and harder to know what's true, and the consequences have been devastating. This hour, TED speakers explore ideas around technology and deception. Guests include law professor Danielle Citron, journalist Andrew Marantz, and computer scientist Joy Buolamwini.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.