title: Predictors of hospital discharge to an extended care facility after major general thoracic surgery.
abstract: Failure to anticipate the need to discharge patients to rehabilitation centers and skilled nursing facilities results in expensive delays in the discharge of patients after surgery. Early identification of patients at high risk for discharge to these extended care facilities could mitigate these delays and expenditures. The purpose of this study was to identify preoperative patient factors associated with discharge to extended care facilities after major general thoracic surgery. Discharge records were identified for all patients undergoing major general thoracic surgery admitted to a university hospital between January 2006 and May 2009 who had a stay of longer than one day. The following risk factors were selected a priori based on clinical judgment: age, preoperative albumin, preoperative Zubrod score, history of peripheral vascular disease, and use of home oxygen. Multiple logistic regression analysis was used to estimate the statistical significance and magnitude of risk associated with each predictor of patient discharge to extended care facilities. Of the 1646 patients identified, 68 (4.1%) were discharged to extended care facilities. Hospital length of stay was on average six days longer for patients discharged to these facilities than for patients discharged home (P < 0.0001). Multivariate analysis demonstrated that advanced age, lower preoperative albumin, and increased preoperative Zubrod score were statistically significant predictors of discharge to extended care facilities. Age, preoperative nutritional status, and functional status are strong predictors of patient discharge to extended care facilities. Early identification of these patients may improve patient discharge planning and reduce hospital length of stay after major thoracic surgery.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Walters
authors.forename: Alykhan S
authors.initials: AS
authors.lastname: Nagji
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Peluso
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Taylor
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D013903:Thoracic Surgery / Q000379:methods*; D016896:Treatment Outcome