title: Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study.
abstract: Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort.
  
  
  
  All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012.
  
  
  
  A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients <60 years and 7.8% in patients ≥80 years). The mortality rate at 1 year was 2.2% among patients aged <60 and 14.1% among patients ≥80 years. At the 1-year follow-up, 4.2% of patients <60 years, 7.9% of patients 60-70 years, 14.4% of patients 70-74 years, 18.5% of patients 75-79 years and 29.1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (<60 years), and 1.4, 7.5 and 16.8% (≥80 years), respectively. Main predictors for living in a nursing home 1 year postoperatively were: age ≥80 years [hazard ratio (HR) 17.8, 95% confidence interval (CI) 7.4-42.8], female sex (HR 1.7, 95% CI 1.1-2.6), previous heart failure (HR 1.6, 95% CI 1.0-2.4), previous myocardial infarction (HR 2.0, 95% CI 1.3-3.2) and previous stroke (HR 3.3, 95% CI 2.1-4.9). Neither urgent nor emergency surgeries were significant predictors for living in a nursing home 1 year postoperatively.
  
  
  
  The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk of nursing home admission was small and dependent on the patient's age, sex and preoperative comorbidities.
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark kristinn.thorsteinsson@rn.dk.
authors.forename: Kristinn
authors.initials: K
authors.lastname: Thorsteinsson
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Andreasen
authors.affiliation: Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Rikke N
authors.initials: RN
authors.lastname: Mortensen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kragholm
authors.affiliation: Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark The Danish Heart Foundation, Copenhagen, Denmark The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
authors.affiliation: Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fonager
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008136:Longevity; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Coronary artery bypass grafting; Home care; Mortality; Nursing home; Octogenarians; Survival