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(Circulation. 1999;100:1461-1462.)
© 1999 American Heart Association, Inc.

Correspondence

Postoperative Readmissions to Hospital Do Not Result From Controlled Early Discharge

Bernard G. Krohn, MD

Good Samaritan Hospital Los Angeles, Calif

	Introduction

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To the Editor:

Dr J.C. Baldwin's editorial comment¹ criticized the report by Dr S.J. Lahey et al, "Hospital Readmission After Cardiac Surgery: Does `Fast Track' Cardiac Surgery Result in Cost Saving or Cost Shifting?"<sup>2</sup> as follows: "It does appear that the `fast track' program being used at this institution is a rather conservative one, which may understate the real differences in readmission rates and the potential impact of hospitals' efforts to shorten LOS [length of stay] for given DRGs [diagnosis-related groups]." This means that if the patients in this study had gone home sooner after surgery than they did, more patients would have been readmitted.

On the contrary, evidence indicates the opposite. In previous studies, patients passed exercise tests, met standardized criteria of fitness for discharge, and were discharged on the third postoperative day. There was no increase in readmission rates.^{3 4} In one study, all 40 patients discharged on the third postoperative day stayed well and were not rehospitalized in the following 2 years.³ If the 417 patients in Lahey's study who were not rehospitalized had performed exercise tests on the third postoperative day, some of them would have passed the tests and could have been discharged promptly without readmission. So, by identifying and sending home sooner the healthiest and strongest patients, Lahey could have reduced the average hospital stay without increasing readmissions.

	References

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1. Baldwin JC. Editorial comment on "Hospital readmission after cardiac surgery: does `fast track' cardiac surgery result in cost saving or cost shifting?" Circulation. 1998;98(suppl II):II-40.

2. Lahey SJ, Campos CT, Jennings B, Pawlow P, Stokes T, Levitsky S. Hospital readmission after cardiac surgery: does "fast track" cardiac surgery result in cost saving or cost shifting? Circulation. 1998;98(suppl II):II-35–II-40.

3. Krohn BG, Kay JH, Mendez AM, Zubiate P, Kay GL. Rapid sustained recovery after cardiac operations. J Thorac Cardiovasc Surg. 1990;100:194–197.[Abstract]

4. Engelman RM, Rousou JA, Flack JE, Deaton DW, Humphrey CB, Ellison LH, Allmendinger PD, Owen SG, Pekow PS. Fast-track recovery of the coronary bypass patient. Ann Thorac Surg. 1994;58:1742–1746.[Abstract]

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