Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach.

Cohort studyJournal of the American Heart Association· Jun 2026

Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach.

Zofia Zdanowicz, Christina Laternser, Colin J Crilly … Joyce L Woo

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Congenital Cardiac SurgeryCohort studyClinical practiceQ1IF 5.3

Discharge barriers explain as much length-of-stay variation as surgical complexity.

Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach.

Zofia Zdanowicz … Joyce L Woo

Journal of the American Heart Association · Jun 2026

Purpose

This study aimed to identify granular discharge barriers after congenital heart surgery and compare the contributions of discharge barriers versus clinical factors to postoperative length of stay (LOS) variation among infants with severe congenital heart defects.

Methods

This was a retrospective cohort study of patients who underwent initial cardiac surgery at ≤12 months, from 2015 to 2021, at a high-volume congenital heart defect surgical center.

n = 752 infants

Results

discharge barriers explain about as much stay length as surgical complexity

8days

No barrier

26days

With barrier

More results

A total of 752 infants met the inclusion criteria; 24.3% experienced a discharge barrier.

The most common discharge barrier category was medical equipment delivery or prior authorization delays (52/752, 6.9%).

More results

Median postoperative LOS for those without and with barriers was 8 (interquartile range, 5-15) and 26 (interquartile range, 14-52) days, respectively ( P <0.001).

In a multivariable analysis, 4 of the 6 barrier categories were associated with higher postoperative LOS when compared with patients without barriers (31%-242%, P =0.000-0.030).

“

Conclusion · 1 of 2

Discharge barriers are as influential as surgical and anatomic complexity in explaining variation in postoperative LOS among infants undergoing congenital heart surgery.

Conclusion · 2 of 2

Future research and clinical efforts to mitigate modifiable discharge barriers may yield improvements in postoperative LOS.

Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach.

Discharge Barriers and Length of Stay Following Congenital Heart Surgery: A Mixed-Methods Approach.

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