Clinical efficacy and economic impact of an enhanced recovery after cardiac surgery program for early discharge

Background: Early discharge (ED) is becoming a crucial component of an enhanced recovery after cardiac surgery (ERACS) program. The aim of this study was to investigate the effectiveness of the implemented ED pathway in the safety and health resource utilization of patients undergoing coronary artery bypass grafting and/or valve surgery.Methods: An ED protocol implemented in 2020 used a set of standard definitions to identify patients eligible for hospital discharge on post-operative days (POD) 3 or 4. Retrospective chart reviews and data collection were conducted.Results: A total of 392 patients were enrolled during the study period. Their median STS mortality risk was 3.3%, and STS risk for long length of stay was 1.3%. Half of the patients were discharged to a step-down unit on POD 1. Moreover, 88 (22%) patients were discharged from hospital on POD 3. The rate of re-hospitalization at 30 days was 3.5%, which is lower than that of a control group of similar patients (4.7%) in 2019. All patients were alive at 30 days. Savings in post-operative hospitalization costs amounted to 2,923,200$ CAD annually during the study period.Conclusions: Implementation of an ED protocol can shorten hospital stays without increasing readmission rates and save costs on post-operative hospitalization. Telephone monitoring following ED is crucial as it can provide ongoing reassurance on post-operative progress and may alleviate the utilization of emergency services in the early post-operative period.