Persistence of risk of death after hospital discharge to locations other than home after cardiac surgery

Makoto Mori; Syed Usman Bin Mahmood; Haoran Zhuo; Sameh Yousef; Jeremy Green; Abeel A Mangi; Yawei Zhang; Arnar Geirsson

doi:10.1016/j.jtcvs.2019.02.079

Persistence of risk of death after hospital discharge to locations other than home after cardiac surgery

J Thorac Cardiovasc Surg. 2020 Feb;159(2):528-535.e1. doi: 10.1016/j.jtcvs.2019.02.079. Epub 2019 Mar 6.

Authors

Makoto Mori¹, Syed Usman Bin Mahmood¹, Haoran Zhuo², Sameh Yousef¹, Jeremy Green³, Abeel A Mangi¹, Yawei Zhang², Arnar Geirsson⁴

Affiliations

¹ Section of Cardiac Surgery, School of Medicine, Yale University, New Haven, Conn.
² Section of Surgical Outcomes and Epidemiology, School of Public Health, Yale University, New Haven, Conn.
³ Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Conn.
⁴ Section of Cardiac Surgery, School of Medicine, Yale University, New Haven, Conn. Electronic address: arnar.geirsson@yale.edu.

PMID: 31272748
DOI: 10.1016/j.jtcvs.2019.02.079

Abstract

Objective: Temporal changes in the risk of postoperative death following cardiac surgery are uncharacterized. We aimed to quantify the duration of postoperative phase with elevated risk of death in patients who underwent cardiac surgery and were discharged to home and destinations other than home.

Method: We conducted a retrospective cohort study of 6894 patients who underwent cardiac surgery between 2008 and 2016 at a tertiary care center in the United States. Logistic regression models with restricted cubic splining along the days since hospital discharge were fitted for risk of death in patients who were discharged to home and those discharged to destinations other than home. The splining curves were analyzed to quantify the duration of postoperative high-risk phase in each cohort.

Results: Mortality rate was significantly higher in the nonhome cohort compared with those discharged to home at 365 days following hospital discharge (9.3% vs 2.1%; P < .001). Discharge to destinations other than home was an independent predictor of late death (hazard ratio, 1.36; 95% confidence interval, 1.15-1.61; P < .001). Analysis of restricted cubic splining curves demonstrated that the postoperative phase with elevated risk of death persisted for 80.3 days in nonhome discharge cohorts, whereas a comparable phase was nonexistent in patients who went home. Predictors of nonhome discharge were identified, with combination of preoperative and postoperative variables yielding C statistics of 0.83.

Conclusions: Hospital discharges to locations other than home following cardiac surgery were associated with an increased risk of late mortality. The postoperative high-risk phase persisted for 80 days in patients who were discharged to locations other than home, supporting the use of 90-day outcome measures as quality metrics. Predictors of discharge to locations other than home were identified, and this may aid in selective intervention to reduce the risk of death in this vulnerable patient population.

Keywords: discharge destinations; outcome measures; postacute phase.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Cardiac Surgical Procedures / mortality*
Female
Home Care Services / statistics & numerical data
Humans
Male
Patient Discharge / statistics & numerical data*
Rehabilitation Centers / statistics & numerical data
Retrospective Studies
Risk Factors
United States

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States