Reducción de la morbilidad y de los costos hospitalarios en cirugía cardiaca, mediante una estrategia prequirúrgica ambulatoria

in our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. since 1999, a fast track to hospitalization program has existed in the national institute of cardiology ignacio chavez for patients with low surgical risk. later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience. objectives: 1) to compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. we compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) to compare the days of hospitalization and money spent by the hospital. methods: we conformed 2 groups of 347 patients. the admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. the monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification. statistical analysis: student t test was conducted on independent samples and numerical variables, and chi square for categorical variables. we considered a p < 0.05 to be statistically significant. results: in average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47± 15 years. the comparison between the groups fast track to hospitalization and admission department waiting list group were: mortality: 4.3% vs. 5.8% (p=0.38). major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). infections: 22 vs. 29 (p = 0.14). mediastinitis: 2 vs. 9 respectivel