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Rapid Discharge After Off Pump Coronary Artery Bypass Grafting - How Safe Is It? - A Propensity Matched Study
Ganesh Kumar K Ammannaya, Balraj Joshi, Nishit Rajyaguru.
K K Patel Super Speciality Hospital, Bhuj, India, Bhuj, India.
OBJECTIVE: While very early discharge ≤ 4 days after full sternotomy off pump coronary artery bypass grafting (OPCAB) is proven safe, cost-effective, and not novel, the term “rapid discharge” to indicate discharge at ≤ 2 days has been put forth more recently. Its advantages can be profound, especially, in resource starved set ups faced with high patient back log. This is the first study till date, aimed at validating the feasibility and safety of such consistent rapid discharges after conventional full sternotomy OPCAB in suitable patients meeting pre-requisite criteria.
METHODS: Of 1268 CABGs who had undergone full sternotomy OPCAB, operated by single surgeon in 3 different centers between May 2021 - April 2025 studied retrospectively, 386 cases that were managed with ultra fast-track protocol and met the criteria for rapid discharge (RD) were compared with conventional discharges (CD). Furthermore, a propensity score model was constructed to overcome the baseline differences between the 2 study groups.
RESULTS: Propensity score matching analysis yielded 235 pairs of CD and RD cohorts and all end points were compared. In-hospital mortality rates (0.85% Vs 0.85%) and 30-day mortality rates (0.43% Vs 0.0%) were comparable with no statistically significant difference. Mean time to extubation (147 ± 65 min Vs 323 ± 90 min), time to mobilization (15.6 ± 1.2 h Vs 32.3 ± 3.3 h) and time to discharge (41.8 ± 5.7 h Vs 103.2 ± 6.8 h) were all significantly shorter (p < 0.001) in RD group. Need for hospital re-admission within 30 days was slightly higher in RD group (1.70% Vs 1.28%), although not statistically significant (p = 0.703). Overall survival and freedom from cardiac death at 1 year in the CD and RD groups were (97.44% Vs 97.87%; p = 0.54) and (97.87% Vs 98.30%; p = 0.55) respectively, with no statistically significant differences.
CONCLUSIONS: Present study is the first study till date analyzing the effectiveness of rapid discharge after conventional full sternotomy OPCAB. ERAS is a multidisciplinary approach that holds great value in judicious utilization of resources while optimizing patient care. Sufficiently powered studies are required to confirm its longer-term outcomes.
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