Skilled care requirements for elderly patients after coronary artery bypass grafting.
OBJECTIVE
To examine the extent to which elderly individuals use various skilled care facilities after coronary artery bypass grafting (CABG).


METHODS
Retrospective cohort study.


METHODS
State of Michigan from 1997 to 1998.


METHODS
Residents aged 65 and older enrolled in Medicare who underwent CABG.


METHODS
Cumulative incidence of admission within 100 days of hospital discharge, relative risk (RR) of admission, readmission or extended stay at a skilled care facility, and length of stay in a skilled care facility.


RESULTS
Fifty percent of patients aged 80 and older used a skilled care facility after CABG, with most requiring admission to a skilled nursing facility (SNF) or readmission to an acute-care hospital within 100 days after discharge. Patients aged 80 and older had a significantly higher risk of admission to a SNF (adjusted RR=3.3, 95% confidence interval (CI)=2.8-4.0) than did those aged 65 to 69, as did patients aged 75 to 79 (adjusted RR=2.2, 95% CI=1.8-2.6) and those aged 70 to 74 (adjusted RR=1.5, 95% CI=1.3-1.8). The length of time spent in skilled care facilities significantly increased with age (mean days=13.3 for aged 65-69, 16.9 for 70-74, 19.6 for 75-79, and 22.9 for 80 and older; P<.001).


CONCLUSIONS
Older patients are more likely to be admitted to a SNF, be readmitted to an acute-care hospital, and have longer institutional stays after CABG. When balancing the risks and benefits of CABG, physicians, patients, families, and policy-makers need to carefully consider the likelihood of follow-up institutional care in elderly patients.
Nallamothu
Brahmajee K
BK
Health Services Research and Development Center of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan 48109, USA. bnallamo@umich.edu
Rogers
Mary A M
MA
Saint
Sanjay
S
McMahon
Laurence J
LJ
Fries
Brant E
BE
Kaufman
Samuel R
SR
Langa
Kenneth M
KM
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000451:nursing*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*