Potential factors affecting the length of hospital stay in patients undergoing coronary artery bypass graft at University Hospitals Coventry and Warwickshire NHS Trust

Abstract

Background Coronary Artery Bypass Graft (CABG) is a surgical procedure to treat patients with severe coronary heart disease. Length of stay (LOS) is an important indicator of the quality of care and effective utilisation of resources in CABG patients. A good knowledge of the factors affecting LOS is important to the multidisciplinary team members that help in the early identification of patients at risk. In addition, identifying the modifiable factors could reduce the significant risk factors for prolonged LOS in CABG patients. Aim This thesis involves a research project conducted with the intention of identifying potential factors which could affect the LOS in patients undergoing CABG at University Hospitals Coventry and Warwickshire NHS Trust. Also, to Identify the association of each factor on the LOS in hospital after CABG and to make recommendations to reduce the LOS and improve patient outcomes by modifying the identified factors. Method A retrospective cohort study conducted on patients above the age of 18 years, who had isolated first time CABG during the year 2017 in UHCW NHS Trust. In this study a systematic sampling method is used to identify a sample of 64 patients out of 350 patients who underwent surgery during the year 2017, who met the inclusion and exclusion criteria. The methodology selected is descriptive and quantitative analysis, as the research question focusses on the association between the variables which includes pre-operative, intra-operative and post-operative factors affecting the LOS after CABG surgery. All collected data obtained have been entered to Microsoft Excel and analysed using descriptive statistical analysis. Results Of the 64 patients, 79% were males and 21% were females. Majority of patients were 60 to 79 years of age. The average LOS was 12 days. While considering the comorbidities, obese patients have the maximum LOS of 13 days. Patients with PVD and COPD, the LOS stay were 16 days and 15 days respectively. Hypertensive patients stayed 13 days and patients with preoperative AF stayed 13 days and those with recent MI and renal dysfunction 12 days, and hypercholesterolemia 11 days. The LOS increases with increasing levels of HbA1c. Hb and Serum albumin didn’t show much relation to LOS so as serum creatinine. The average LOS for emergency CABG was 19 and elective 7 days. Considering CPB time <1.45 hours, average LOS was 8 days, compared to 17 days for CPB time >1.45 hours. Cross clamp time ≤75 minutes was 9 ± 5days, compared to 18 days for patients with 76- 150 minutes. LOS for duration of surgery between 2-3 ½ hours was 9 days and 3 ½ - 4 hours and 59 minutes was 13 days and >5 hours was 16 days. Conclusion There is no association observed in LOS and Preoperative factors such as serum Hb, HbA1C, serum albumin and serum creatinine. However, surgical factors are related to LOS. When the CBP time, cross clamp time and surgery duration increase the LOS also increases. Other factors such as male gender, smoking and emergency procedure are also contributing to increased LOS.

Date of Award	2020
Original language	English
Awarding Institution	Coventry University
Supervisor	Mike Price (Supervisor) & Doug Thake (Supervisor)