Early Discharge After Minimally Invasive Aortic and Mitral Valve Surgery.

Abstract

BACKGROUND\nWe investigated patient outcomes in relation to their postoperative length of stay after minimally invasive valve surgery.\n\n\nMETHODS\nAll adults who survived elective, uncomplicated minimally invasive aortic or mitral valve surgery at a single center between 2012 and 2019 were classified by postoperative length of stay: early discharge (≤ 3 days) or late discharge (> 3 days). The trend in early discharge was investigated over the study period, predictors of early discharge were identified using multivariable logistic regression modeling, and one-to-one propensity score matching was used to determine which patients in the late-discharge cohort of similar health to patients discharged early. Adjusted outcomes of 30-day mortality, readmission, and direct costs were analyzed.\n\n\nRESULTS\nAmong 1,262 consecutive minimally invasive valve patients, 618 were elective and uncomplicated, 25% (n=162) of whom were discharged early. The proportion of early-discharge patients increased over time (p for trend <0.05). A history of congestive heart failure, stroke, or smoking and higher Society of Thoracic Surgeons predictive risk of mortality score negatively predicted early discharge (p<0.05). Propensity score matching identified 101 (22%) late-discharge patients comparable to early-discharge counterparts. Adjusted 30-day mortality and readmission rates were comparable between cohorts. The median direct costs per patient ($20,046 vs. $22,124; p<0.05) were significantly lower in the early-discharge cohort.\n\n\nCONCLUSIONS\nIn well-selected patients, early discharge after minimally invasive valve surgery was associated with lower costs but comparable postoperative outcomes. About one fifth of patients who remain in the hospital beyond postoperative day 3 may be candidates for earlier discharge.