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Eur J Cardiothorac Surg 1999;16:222-227
© 1999 Elsevier Science NL

Surgical versus medical care for postoperative cardiac surgical patients at the general ward

^b Department of Cardiac Surgery of the Ludwig-Maximilians-University of Munich at Augustinum,81375 Munich, Germany
^a Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, 81375 Munich, Germany
^c Department of Anesthesiology of the Ludwig-Maximilians-University Munich, at Augustinum, 81375 Munich, Germany

Corresponding author. Department of Cardiac Surgery, University Clinic of Ulm, Steinhoevelstrasse 9, D-89075 Ulm, Germany. Tel.: +49-731-5022-7322; fax: +49-731-502-6698
e-mail: oliver.goedje{at}medizin.uni-ulm.de

Objectives: To shorten hospital stay after cardiac surgery, several risk factors have been defined to identify patients who can be discharged early. These risk factors are dependant on the patient; no studies exist on the influence of the treating physician himself on postoperative patient stay. Methods: In a university affiliated cardiac surgical clinic we investigated patients who were postoperatively treated either on medical wards with no cardiac surgeon's presence or on a cardiac surgical ward; at both types of wards physicians had several years experience with cardiac surgical patients. Taking several risk factors for postoperative morbidity into account, postoperative length of stay and incidence of wound healing complications have been compared. Results: Within a 3-month period, 84 patients were treated at the cardiac surgical ward, 102 patients at the medical wards. Risk factors for postoperative morbidity were present in 87% of patients, statistically independent of postoperative wards. Although demographic data and median ICU-stay of both patient groups was comparable, the median post-ICU stay was 9 days at the surgical and 13 days at the medical wards (P<0.0001). Incidence of wound healing complication was higher (19.6%) at the medical wards than at the surgical ward (10.7%), without reaching statistical significance. Conclusion: As patients at the respective wards were statistically not different, the difference in post-ICU stay, infection and costs must depend on the treating physicians. As a consequence, postoperative care for cardiac surgical patients in all cases should include direct cardiac surgical participation.

Key Words: Postoperative patient care • Postoperative length of stay • Risk factors • Cardiac surgery • Infection

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