부산대학교 도서관

Background: Prolonged postoperative stay (POS) in patients undergoing CABG is associated with increased cost, inefficient utilization of resources, and poor quality of care (QOC). We aim to identify predictors of prolonged POS and evaluate the overtime impact of multidisciplinary team (MDT) QOC protocols on POS at a newly established tertiary care center.Methods: A total of 1168 consecutive patients undergoing isolated CABG between 2015-2022 were evaluated. POS was identified as prolonged (>6 days) and short (≤ 6 days). Short vs. prolonged stay groups were compared by appropriate testing methods. Predictors of prolonged POS were determined by multivariable logistic regression. Trends in prolonged POS were determined using Joinpoint Software to calculate the average annual percentage change (AAPC).Results: Overall, 44.3% (517/1168) of patients had prolonged POS. Patients in the prolonged POS group were older (59.1±10.5 vs. 56.3± 9.5, P<0.001), more likely females (16.6% vs. 9.7%, P<0.001), and had a higher burden of hypertension (88.1% vs. 81.9%, P=0.004), and diabetes (74.8% vs. 62.7%, P<0.001). The prolonged POS group featured worse ejection fraction, higher serum creatinine, and more frequently required preoperative intra-aortic balloon pump insertion (Table). On multivariable logistic regression, age, female gender, NYHA class ≥II, history of diabetes, preoperative creatinine level, preoperative EF, and preoperative IABP placement were independent predictors of prolonged POS (Figure A). Between 2015-2022, more QOC protocols were initiated, with a 67% relative reduction in the proportion of patients with prolonged POS (85.7% to 28.3%), with an AAPC of -12.8, 95% CI [-16.3, -9.2], P<0.001 (Figure B).Conclusion: Initiating MDT QOC protocols was associated with a reduction in POS among patients undergoing CABG. Identifying predictors of prolonged POS can help in timely planning of milestones aimed at eliminating unnecessary POS.