Discharge to home decreasing after higher risk CABG

Image: PD 

1. Higher surgical risk coronary artery bypass graft (CABG) patients have a lower likelihood of postoperative discharge to home. 

2. The Society of Thoracic Surgery (STS) mortality risk score for CABG accurately predicted discharge disposition.  

Evidence Rating Level: 2(Good) 

Study Rundown: As more high risk patients undergo coronary artery bypass graft (CABG) operations, a higher proportion will require skilled care and rehabilitation postoperatively and cannot be discharged directly to their homes. This aspect of the postoperative course is important in patients’ decision whether or not to undergo surgery, but is not clearly outlined to many patients. Part of the reason is incomplete information regarding the increase in risk of discharge to places other than home as intraoperative surgical risk increases.

This observational study found a statistically significant positive correlation between risk of discharge not to home and perioperative risk of mortality. The risk of discharge not to home was substantial, exceeding 20%, even in patients with low-moderate risk of mortality. Given that CABG is performed on older patients for whom quality of life gains are the reason for surgery more than increase in life expectancy, and that postoperative rehabilitation is a significant component of quality of life, this data could provide a more complete picture to patients and policymakers on which patients will benefit from CABG. The generalizability of this study is limited by restriction of analysis to two heart surgery centers in Texas.

Click to read the study in Annals of Thoracic Surgery

In-Depth [retrospective study]: 5,119 patients who underwent CABG surgery from 2004 to 2011 were reviewed for discharge outcome. 484 patients (9.4%) were discharged not to home: 216 patients (4.21%) were discharged to a nursing home, 153 (2.99%) to a rehabilitation center, and 115 (2.25%) to a long-term care facility. Likelihood of discharge to home decreased as STS risk score, a surgical risk calculation used in cardiac surgery, increased (p<0.001). Age and marital status were also significant predictors of discharge status (p<0.001).

By Gina Siddiqui and Chaz Carrier

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