ArticleBMJ open2017
Effect of individual patient risk, centre, surgeon and anaesthetist on length of stay in hospital after cardiac surgery: Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) consecutive cases series study of 10 UK specialist centres.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis.BMC cardiovascular disorders · 2021Pooled it
- Smart bracelet to assess physical activity after cardiac surgery: A prospective study.PloS one · 2020Trial
- A mobilization poster stimulates early in-hospital rehabilitation after cardiac surgery: a prospective sequential-group study.Journal of cardiothoracic surgery · 2023Article
- Random effects modellingFrontiers in pharmacology · 2023Article
- Improving service efficiency and throughput of cardiac surgery patients using Monte Carlo simulation: a queueing setting.Scientific reports · 2022Article
- Social and emotional factors as predictors of poor outcomes following cardiac surgery.Interactive cardiovascular and thoracic surgery · 2022Article
- Is There a Surgeons' Effect on Patients' Physical Health, Beyond the Intervention, That Requires Further Investigation? A Systematic Review.Therapeutics and clinical risk management · 2022Review
- Is There a Doctors' Effect on Patients' Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review.Therapeutics and clinical risk management · 2022Review
- The Doctors' Effect on Patients' Physical Health Outcomes Beyond the Intervention: A Methodological Review.Clinical epidemiology · 2022Article
- Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (Journal of clinical medicine · 2021Review
- Consensus Defined Diastolic Dysfunction and Cardiac Postoperative Morbidity Score: A Prospective Observational Study.Journal of clinical medicine · 2021Article
- Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty.Bone & joint open · 2021Article
- Including random centre effects in design, analysis and presentation of multi-centre trials.Trials · 2021Article
- Predictors of Length of Stay in Intensive Care Unit after Coronary Artery Bypass Grafting: Development a Risk Scoring System.Brazilian journal of cardiovascular surgery · 2021Article
- Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo determine the relative contributions of patient risk profile, local and individual clinical practice on length of hospital stay after cardiac surgery.
designTen-year audit of prospectively collected consecutive cardiac surgical cases. Case-mix adjusted outcomes were analysed in models that included random effects for centre, surgeon and anaesthetist.
settingUK centres providing adult cardiac surgery.
participants10 of 36 UK specialist centres agreed to provide outcomes for all major cardiac operations over 10 years. After exclusions (duplicates, cases operated by more than one consultant, deaths and procedures for which the EuroSCORE risk score for cardiac surgery is not appropriate), there were 107 038 cardiac surgical procedures between April 2002 and March 2012, conducted by 127 consultant surgeons and 190 consultant anaesthetists.
main outcome measureLength of stay (LOS) up to 3 months postoperatively.
resultsThe principal component of variation in outcomes was patient risk (represented by the EuroSCORE and remaining patient heterogeneity), accounting for 95.43% of the variation for postoperative LOS. The impact of the surgeon and centre was moderate (intra-class correlation coefficients ICC=2.79% and 1.59%, respectively), whereas the impact of the anaesthetist was negligible (ICC=0.19%). Similarly, 96.05% of the variation for prolonged LOS (>11 days) was attributable to the patient, with surgeon and centre less but still influential components (ICC=2.12% and 1.66%, respectively, 0.17% only for anaesthetists). Adjustment for year of operation resulted in minor reductions in variation attributable to surgeons (ICC=2.52% for LOS and 2.23% for prolonged LOS).
conclusionsPatient risk profile is the primary determinant of variation in LOS, and as a result, current initiatives to reduce hospital stay by modifying consultant performance are unlikely to have a substantial impact. Therefore, substantially reducing hospital stay requires shifting away from a one-size-fits-all approach to cardiac surgery, and seeking alternative treatment options personalised to high-risk patients.
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