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Original Articles

Increasing Healthcare Resource Utilization After Coronary Artery Bypass Graft Surgery in the United States

Madhav Swaminathan, MD; Barbara G. Phillips-Bute, PhD; Uptal D. Patel, MD; Andrew D. Shaw, FRCA; Mark Stafford-Smith, MD; Pamela S. Douglas, MD; Laura E. Archer, MS; Peter K. Smith, MD and Joseph P. Mathew, MD

From the Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology (M.S., B.G.P.-B., A.D.S., M.S.-S., J.P.M.); the Duke Clinical Research Institute (U.D.P., P.S.D.), Division of Thoracic Surgery; the Department of Surgery (P.K.S.); and the Division of Biostatistics, Duke Comprehensive Cancer Center (L.E.A.), Duke University Medical Center, Durham, NC.

Correspondence to Madhav Swaminathan, MD, Associate Professor of Anesthesiology, Department of Anesthesiology, Box 3094, DUMC, Duke University Medical Center, Durham, NC 27710. E-mail swami001{at}mc.duke.edu

Received October 28, 2008; accepted March 9, 2009.

Background— Despite declining lengths of stay, postdischarge healthcare resource utilization may be increasing because of shifts to nonacute care settings. Although changes in hospital stay after coronary artery bypass graft (CABG) surgery have been described, patterns of discharge remain unclear. Our objective was to determine patterns of discharge disposition after CABG surgery in the United States.

Methods and Results— We examined discharge disposition after CABG procedures from 1988 to 2005 using the Nationwide Inpatient Sample. Discharges with a "nonroutine" disposition defined patients discharged with continued healthcare needs. Multivariable regression models were constructed to assess trends and factors associated with nonroutine discharge. Median length of stay among 8 398 554 discharges decreased from 11 to 8 days between 1988 and 2005 (P<0.0001). There was a simultaneous increase in nonroutine discharges from 12% in 1988 to 45% in 2005 (P<0.0001), primarily comprising home healthcare and long-term facility use. Multivariable regression models showed age, female gender, comorbidities, concurrent valve surgery, and lower-volume hospitals more likely to be associated with nonroutine discharge.

Conclusions— We found a significant increase in nonroutine discharges after CABG surgery across the United States from 1988 to 2005. The significant shortening of length of stay during CABG may be counterbalanced by the increased requirement for additional postoperative healthcare services. Nonacute care institutions are playing an increasingly significant role in providing CABG patients with postdischarge healthcare and should be considered in investigations of postoperative healthcare resource utilization. The impact of these changes on long-term outcomes and net resource utilization remain unknown.

Key Words: coronary disease • surgery • bypass • epidemiology • mortality