title: Patient disposition and long-term outcomes after valve surgery in octogenarians.
abstract: BACKGROUND
  Valve surgery is performed routinely in octogenarians. This study explored variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival.
  
  
  METHODS
  Patients 80 years or older who presented for aortic valve or mitral valve surgery from 2002 to 2010 were included. Baseline demographic, perioperative, and long-term outcomes were captured. Disposition was categorized into 2 groups; home (n=184) or other facility (n=123). The National Death Index and Social Security Death Index verified deaths.
  
  
  RESULTS
  Mean age was 82.9±2.5; 46% (140 of 307) were female. Discharge location logistic regression, adjusted for gender (odds ratio [OR]=1.45, p=0.17) and European System for Cardiac Operative Risk Evaluation score (OR=1.09, p=0.10), predicted that older (OR=1.18, p<0.001), unmarried (OR=2.07, p=0.006) patients with at least 1 major complication (OR=3.86, p<0.001) were more likely to be not discharged home. Kaplan-Meier analysis found significantly lower 1- and 2-year (85.8% vs 94.6%, p=0.009; 80.1% vs 90.3%, respectively, p=0.01) cumulative survival in patients not discharged home. A multivariate Cox proportional hazards model demonstrated poorer 1- and 2-year survival (hazard ratio [HR]=2.56, p=0.04; HR=2.06, p=0.05, respectively). Predictors of follow-up mortality for patients not discharged home were length of stay (OR=1.06, p=0.03) and any major complication (OR=6.90, p=0.002); lower body mass index was marginally significant (OR=1.12, p=0.06). The significant predictor for patients discharged home was length of stay (OR=1.17, p=0.002).
  
  
  CONCLUSIONS
  Octogenarians can expect excellent survival after valve surgery. Those not discharged home had poorer long-term survival. Therefore, adequate resources should be secured so sicker patients receive the appropriate level of care.
authors: Inova Heart and Vascular Institute, Falls Church, Virginia 22042, USA. linda.henry@inova.org
authors: Linda
authors: L
authors: Henry
authors: Linda
authors: L
authors: Halpin
authors: Sharon
authors: S
authors: Hunt
authors: Sari D
authors: SD
authors: Holmes
authors: Niv
authors: N
authors: Ad
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome