Discharge barriers are as influential as surgical and anatomic complexity in explaining variation in postoperative length of stay among infants undergoing congenital heart surgery.
Approximately one in four infants undergoing congenital heart surgery experienced a discharge barrier.
The most common discharge barrier category was medical equipment delivery or prior authorization delays.
Infants who experienced a discharge barrier had substantially longer postoperative length of stay than those without barriers.
Four of six discharge barrier categories were independently associated with significantly higher postoperative length of stay in multivariable analysis.
Discharge barriers and surgical complexity contributed nearly equal and substantial amounts of variation to postoperative length of stay.
This research suggests that non-medical, logistical obstacles to going home from the hospital — called discharge barriers — play just as large a role as the complexity of a baby's heart surgery in determining how long that baby stays in the hospital after the operation. The study followed 752 infants who had heart surgery in their first year of life at a major pediatric heart center between 2015 and 2021. About one in four of these infants experienced some kind of discharge barrier, with the most common being delays in getting medical equipment delivered or obtaining insurance authorization for home supplies. Babies who faced these barriers stayed in the hospital a median of 26 days, compared to 8 days for babies without barriers. Using a statistical method to parse out how much each factor contributes to differences in hospital length of stay, the researchers found that discharge barriers and surgical complexity each explained roughly one-fifth of the variation in how long patients stayed — a nearly identical contribution from a logistical problem as from the inherent difficulty of the surgery itself. Four out of six specific types of discharge barriers were independently associated with stays that were 31% to 242% longer than average. This research suggests that discharge barriers represent a meaningful and potentially modifiable target for reducing prolonged hospital stays in this vulnerable population. Unlike surgical complexity, which is largely fixed by the nature of a child's heart condition, discharge barriers such as equipment delays or insurance authorization problems may be addressable through better care coordination, earlier planning, or policy changes — offering a possible avenue for improving outcomes and reducing the burden on families and health systems.
Zdanowicz Z, Laternser C, Crilly C, Kan K, Lay A, Woo J. (2026). Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047918