The value of days alive and out of hospital 30 days after surgery as an outcome measure in a major cardiac surgical center in Australia

Abstract

Objective

Postoperative days alive and out of hospital within 30 days (DAH-30) is a validated, patient-centered metric reflecting the quality of care and recovery after surgery. This study aimed to evaluate the feasibility of DAH-30 data collection in an Australian cardiac surgical center and investigate its association with established cardiac risk factors and postoperative complications.

Methods

This retrospective cohort study used prospectively collected registry data from patients aged ≥18 years undergoing open-heart surgery. DAH-30 was calculated as the total number of days alive and out of hospital within the first 30 postoperative days, incorporating manually collected data on secondary facility discharge and readmission. Univariable associations were assessed using the Kruskal-Wallis rank sum test. Multivariable analysis used a backward stepwise selection procedure on the parameters of a beta-inflated regression model. Estimated coefficients, 95% confidence intervals, and P values were reported.

Results

DAH-30 data collection was efficiently integrated into routine clinical workflow. The median DAH-30 for the cohort was 21 days (interquartile range, 14-23), with 10.6% of patients spending no time at home within 30 days. Univariable analysis revealed significant associations between several preoperative risk factors and postoperative complications with DAH-30. Multivariable analysis identified age, postoperative arrhythmias, and preoperative infective endocarditis as independent predictors of reduced DAH-30.

Conclusions

DAH-30 is a feasible, meaningful patient-centered outcome metric that can be efficiently collected using routine clinical data in an Australian cardiac surgical center. It provides valuable insights into patient recovery by integrating the impact of preoperative risk, postoperative complications, and hospital use. DAH-30 holds potential as an important outcome measure in cardiac surgery for guiding clinical practice, informing quality improvement, and monitoring intervention effectiveness.