Researchers are studying the discharge process after cardiac surgery because the rate of rehospitalization after cardiac surgery has been reported at up to 22 percent. Researchers are investigating the potentially modifiable elements in the discharge process.
The discharge process is one of the most important phases of hospitalization. Hospital discharge is an intricate and dynamic process requiring choreography of patients, physicians, ancillary staff and outpatient caregivers.
Hospitals reduce readmission after a person has heart surgery by developing programs that include discharge education, detailed medication instructions, postoperative care coordination and routine phone calls for four weeks after discharge.
In this type of program, people who have had heart surgery and have been discharged home received discharge kits equipped with wireless-enabled blood pressure monitors, oximeters, weight scales and miniaturized electrocardiogram sensors synced to a mobile tablet device. The mobile application prompts people to perform daily measurements and answer questions regarding pain, physical activity and surgical wound appearance. People's responses are initially screened by telemonitoring companies who generate summary reports.
Then the hospital's cardiac surgery discharge staff reviews any information that falls outside of the normal range and triages the details to the appropriate provider for swift, real-time interventions. Resources such as these, in addition to improved access to expert advice following hospitalization, have significant potential to impact a person's outpatient trajectory.
Predictors of rehospitalization after heart surgery include the use of preoperative beta blockers, tobacco use and surgical site infections. Researchers have found that these are independent predictors of rehospitalization within 30 days for people who have undergone major heart surgery.
Weekend or holiday discharge does not lead to a higher chance of readmission after heart surgery. Despite a common belief that weekend and holiday discharge after major heart surgery may impact hospital readmissions, research published in The Annals of Thoracic Surgery showed that day of discharge does not affect readmissions.
The so-called weekend effect has been described as worse outcomes attributed to decreased staffing and increased transitions of care.
Researchers were surprised to find that people discharged on weekends and holidays had similar readmission rates and outcomes as people who were cleared on weekdays. Researchers encourage people to be engaged in the discharge process early on and to understand that returning home on a weekend does not mean they will have a higher chance of rehospitalization.
People with diabetes mellitus who undergo heart bypass surgery for multiple blocked arteries have a significantly better five-year survival rate than diabetic patients who undergo angioplasty with drug-eluting stents (DES), according to a study published in The Annals of Thoracic Surgery.
Study researcher Rephael Mohr, MD, of Israel's Tel Aviv Sourasky Medical Center, explained that coronary arterial blood vessels in diabetic patients are smaller, which increases the risk of new blockages of the blood vessels after treatment with stents.
The study is the first comparative effectiveness demonstration of coronary artery bypass grafting (CABG) surgery using both internal thoracic arteries versus percutaneous coronary intervention (PCI) with DES in patients with diabetes.
Rephael Mohr, MD, Yaron Moshkovitz, MD, and colleagues reviewed 5-year outcomes for 226 patients who underwent bilateral internal thoracic artery (BITA) grafting with outcomes for 271 patients who underwent PCI with DES. They found that BITA patients had a 13 percent greater survival rate, as well as a lower risk for non-fatal heart attacks, recurrent chest pain, and future re-interventions. Additionally, they found that the more stents that were used, the greater the risk of a major cardiovascular event.
“The long-term benefit of BITA bypass graft surgery is probably related to the protection provided by CABG conduits that bypass the blockages and protect against future blockages,” said Dr. Mohr. “Protection from recurrent coronary events due to disease progression cannot be achieved by the stents placed in the coronary arteries during heart catheterization.”
Watch the video to learn more about TAVR and hear from Vamsee Yaganti, MD, from Heart Center at St. Mark's, and his prediction if the procedure will become more widespread in the future.
Hospitals can improve coronary artery bypass grafting (CABG) outcomes through designated leadership of a coronary surgery program, standardization of all aspects of coronary care, and rigorous quality review. With a more focused surgeon, team and program—specialized coronary teams to improve all aspects of care—more people undergoing CABG could survive.
A specialized coronary artery bypass grafting (CABG) surgery program can decrease overall operation time by 48 minutes from incision to closure, according to researchers at the University of Maryland Medical Center (UMMC). In the UMMC specialized CABG surgery program, surgical approach and operative techniques were standardized, resulting in decreased operation time.
A specialized approach to coronary artery bypass grafting (CABG) has been shown to improve mortality rates. Researchers at the University of Maryland Medical Center reviewed survival data for people who had CABG under a specialized CABG surgery program compared to people who underwent CABG during an earlier period when a general approach was used. The research showed that mortality decreased from 2.67 percent to 1.48 percent after just three years of the more specialized coronary surgery program. As a result, it is estimated that specialization in CABG surgery prevented five deaths during that time period.
You should find a specialized team for your coronary artery bypass grafting (CABG) surgery because a surgeon dedicated to coronary bypass and working with a specialized team may have better outcomes. While all cardiac surgeons can perform a bypass operation, people who undergo CABG—the most common heart surgery performed—may live longer and experience fewer complications when under the care of a highly focused surgical team that uses simplified and standardized approaches. Researchers have found many operative factors and clinical outcomes to be significantly improved, demonstrating the effects of team and program specialization.