Risk for non-home discharge following surgery for ischemic mitral valve disease.
Publication/Presentation Date
12-1-2021
Abstract
OBJECTIVES: To determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR).
METHODS: Discharge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed.
RESULTS: NHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P = .006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P < .001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P = .002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P = .03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P = .01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P < .001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P = .03), respectively. QOL did not differ significantly between groups.
CONCLUSIONS: NHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.
Volume
162
Issue
6
First Page
1769
Last Page
1778
ISSN
1097-685X
Published In/Presented At
Lala, A., Chang, H. L., Liu, X., Charles, E. J., Yerokun, B. A., Bowdish, M. E., Thourani, V. H., Mack, M. J., Miller, M. A., O'Gara, P. T., Blackstone, E. H., Moskowitz, A. J., Gelijns, A. C., Mullen, J. C., Stevenson, L. W., & Cardiothoracic Surgical Trials Network (CTSN) Working Group (2021). Risk for non-home discharge following surgery for ischemic mitral valve disease. The Journal of thoracic and cardiovascular surgery, 162(6), 1769–1778.e7. https://doi.org/10.1016/j.jtcvs.2020.02.084
Disciplines
Medicine and Health Sciences
PubMedID
32307181
Department(s)
Department of Surgery
Document Type
Article