Post-discharge care after adult cardiac surgery: a national survey of UK National Health Service centres

Background

Perioperative mortality has declined substantially after cardiac surgery, but morbidity, mortality and readmission after discharge remain significant. In the UK, around one in six patients undergoing coronary artery bypass grafting (CABG) and one in four undergoing valve surgery are readmitted within a year. Post-discharge care is poorly defined and has not been systematically described across UK cardiac surgery centres.

Methods

We conducted a national, electronically administered, centre-level survey of all 35 UK National Health Service adult cardiac surgery centres. A single clinician representative from each centre reported institutional rather than personal practice. The survey assessed discharge and follow-up arrangements, complication surveillance, cardiac rehabilitation, psychological and cognitive support and consideration of socioethnic and economic characteristics.

Results

33/35 (94%) centres responded. Discharge provision varied substantially. Only 6/30 centres (20%) screened patients at discharge for high risk of complications, 6/30 (20%) provided remote monitoring and 12/30 (40%) provided psychological support. Consideration of equity, access and inclusion was also limited; disability was considered by 19/33 centres (58%), while 10/33 centres (30%) reported considering no demographic characteristics. Immediate discharge processes were largely standardised, including wound-care information (31/31, 100%), cardiac rehabilitation referral after CABG surgery (31/33, 94%), communication with primary care (31/33, 94%) and routine resident-led follow-up (30/33, 91%). Centres identified unmet needs in psychological support, post-discharge monitoring, physiotherapy support and cardiac rehabilitation.

Conclusions

The process of hospital discharge was broadly consistent across UK cardiac surgery centres, but post-discharge care and support varied widely across centres. These findings identify priorities for defining and evaluating a more consistent post-discharge pathway.