Health status and social risk correlates of extended length of stay following coronary artery bypass surgery.
BACKGROUND
Preoperative severity of illness in patients undergoing coronary artery bypass grafting (CABG) surgery is a major determinant of clinical postoperative outcomes and surgical length of stay (SLOS). Preoperative patient reported health status and social risk have not been quantified as predictors of SLOS post-CABG. Our hypothesis was that poorer self-reported health and greater social risk, as measured by standardized instruments, are significantly associated with extended SLOS defined as greater than or equal to 7 days.


METHODS
In the pilot phase of the Washington State Clinical Outcomes Assessment Program (COAP) patients in a case series between 1995 and 1996 at all hospitals with a cardiac surgery program were administered preoperative SF-36 and Seattle Angina Questionnaires (SAQ) in addition to the collection of prospective clinical data with Society of Thoracic Surgeons' compatible definitions (n = 1073). Factors found significant from bivariate analysis were incorporated into a logistic regression model to assess relative association with extended SLOS (>/= 7 days).


RESULTS
The final model included the following elements in descending order of significance: site, SF-36 health perceptions (HP) scale, social risk factors, age, intraaortic balloon pump, congestive heart failure, comorbidity score more than 2, preoperative days more than 2, emergency operation, prior CABG, and gender.


CONCLUSIONS
The HP subscore of the SF-36 and the composite social risk factors score were significantly associated with extended SLOS after controlling for other standard clinical variables. "Hospital site" remained the factor with the greatest variance independent of patient severity of illness.
Johnston
Gilbert
G
St. Joseph Medical Center, Tacoma, Washington, USA. gilj@nwheartcenter.com
Goss
J Richard
JR
Malmgren
Judith A
JA
Spertus
John A
JA
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012306:Risk; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D014861:Washington