title: Long-term fate of patients discharged to extended care facilities after cardiovascular surgery.
abstract: BACKGROUND
  The Society of Thoracic Surgeons predictive algorithms can be used to help patients understand the risks in having a surgical procedure. However, elderly patients are frequently more concerned about the quality of their remaining life and whether they will return home. Currently, we have no predictors of which patients are likely to return to independent living after surgery. We followed patients discharged home or to an extended care facility to determine which patients were most likely to return home and be alive at one year.
  
  
  METHODS
  This single-hospital, retrospective study followed 590 cardiac surgery patients (January 2008 to December 2009) for at least 1 year after discharge. Follow-up data were collected by contacting facilities, patients, and families, and Social Security Death Index searches.
  
  
  RESULTS
  At hospital discharge, 84.4% went home, 3.7% to rehab, 7.5% to skilled nursing facilities (SNF), and 4.4% to a long-term acute care facility (LTAC). Predictors for facility discharge include increasing age, female, dialysis, emergent status, procedures other than CAB, preoperative stroke, and moderate to severe tricuspid insufficiency. The most significant predictors of dying or still being in a facility at 1 year include being on dialysis, right heart failure, and having chronic lung disease. Considering perioperative complications, requiring prolonged ventilation decreases the odds of being home and alive at 1 year by 67%: one-year survival at home, 95.4%; rehabilitation, 63.6%; SNF, 52.3%; and LTAC, 30.8%.
  
  
  CONCLUSIONS
  Many patients discharged to extended care do not return to their previous lifestyle; only 30.8% of those requiring care in a LTAC facility are alive at home at 1 year.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. jimmyedgertonmd@gmail.com
authors.forename: James R
authors.initials: JR
authors.lastname: Edgerton
authors.forename: Morley A
authors.initials: MA
authors.lastname: Herbert
authors.forename: Cecile
authors.initials: C
authors.lastname: Mahoney
authors.forename: Drew
authors.initials: D
authors.lastname: Armstrong
authors.forename: Todd M
authors.initials: TM
authors.lastname: Dewey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holper
authors.forename: Karen
authors.initials: K
authors.lastname: Roper
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D015996:Survival Rate; D013997:Time Factors
keywords: 18; 4