Study on the construction and application effect of discharge preparation services in heart valve replacement surgery

Objective To develop and evaluate a discharge preparation service (DPS) for patients after heart valve replacement surgery. Method This retrospective cohort study included 323 patients who underwent heart valve replacement surgery between February 2023 and January 2025. A multidisciplinary DPS plan was developed using a modified Delphi method and implemented in clinical practice. After 1:1 propensity score matching, 110 patients receiving DPS and 110 receiving usual care were analyzed. RHDS and QDTS were assessed at discharge; CSMS, CCQQ, and NSNS were assessed at discharge and at 3 and 6 months after discharge. Linear mixed models examined time, group, and time × group interactions. Results All items in the DPS plan were agreed upon by experts (average importance score ≥4.0, coefficient of variation ≤0.25), with a Kendall's coefficient of concordance W value of 0.925 ( P < 0.001), and the expert authority coefficient was 0.914. After propensity score matching (PSM), there were no significant differences in baseline characteristics between the two groups ( P > 0.05, standardized mean difference <0.1). Compared with controls, the DPS group had significantly higher RHDS and QDTS scores at discharge ( P < 0.05). For CSMS, CCQQ, and NSNS, time × group interactions were significant [CSMS: F(2,436) = 77.73; CCQQ: F(2,436) = 93.92; NSNS: F(2,436) = 67.53; all P < 0.001], indicating steeper improvement trajectories with DPS. At 6 months after discharge, the interaction estimates were 11.23 (95% CI 9.23–13.23) for CSMS, 15.61 (95% CI 13.36–17.86) for CCQQ, and 10.40 (95% CI 8.60–12.20) for NSNS (all P < 0.001). DPS was associated with lower unplanned readmission (6.36% vs. 15.45%, P = 0.031) and lower total complications (25.45% vs. 59.09%, P < 0.001). Conclusion The systematic, multidisciplinary DPS plan was associated with significant improvements in discharge readiness, self-management ability, and quality of life, as well as lower rates of unplanned readmissions and complications after heart valve replacement surgery.