Selection of patients for same-day coronary bypass operations

Abstract

Between March 15, 1990, and December 31, 1991, we admitted to the Virginia Mason Hospital for isolated coronary bypass operations 175 consecutive patients with chronic, stable angina pectoris who had prior coronary arteriography. One hundred patients were admitted on the same day as their operations, and 75 patients, deemed to be at higher risk, were admitted 1 day before the operation. Postoperative progress of all patients was monitored by means of a clinical pathway form with physiologic and activity measures plotted against postoperative days. We found no difference in age, sex, or total number of comorbidity factors. Diabetes and ejection fraction less than 0.50 were significantly more common in preoperatively admitted patients and were independently predictive of admitting group. Significant differences between surgeons in the proportion of same-day patients admitted could not be explained by differences in common risk factors. There was no significant difference in postoperative major or minor complications or number of clinical pathway deviations, but two deaths occurred in patients admitted preoperatively. Average total hospital stay was 1 1/2 days less for same-day patients, a highly significant difference. Total hospital charges averaged $19,000 for the series and were $286 more for preoperatively admitted patients, a difference that was not statistically significant. Patients admitted selectively for same-day coronary bypass are not at risk for an increased number of complications. Although their hospital stay is reduced, the reduction of their hospital charges is minimal. Preoperative admission of patients with comorbidity requiring medical management or with physical incapacity remains justified, and admitting decisions should remain with the operating surgeon, not third parties.