A Pragmatic Preoperative Prediction Score for Nonhome Discharge After Cardiac Operations

Stuebe, Jenna; Rydingsward, Jessica E.; Lander, Heather; Ng, Jillian; Xu, Xinling; Kaneko, Tsuyoshi; Shekar, Prem; Muehlschlegel, Jochen D.; Body, Simon C.

doi:10.1016/j.athoracsur.2017.11.060

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…Another important observation in our study, is that women had higher rate of nonhome discharge compared with men (11.3% vs 6.9%, p < .01). These findings concur with other studies, which showed that female sex has high association with nonhome discharge after TAVR and cardiac surgeries 25,26 …”

Section: Discussionsupporting

confidence: 93%

Sex‐stratified analysis of the safety of percutaneous left atrial appendage occlusion

Patel

Munir

Kawsara

et al. 2020

Cathet Cardio Intervent

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Objectives and Background There is insufficient current evidence about whether sex impacts outcomes of percutaneous left atrial appendage occlusion (LAAO). The aim of this study was to investigate the association between sex and short‐term outcomes of LAAO. Methods Patients who were hospitalized and underwent LAAO from October 2015 to December 2017 in the National Readmission Database were queried. The primary endpoint of interest was major in‐hospital adverse events. Secondary endpoints included, 30‐day readmission rate, nonhome discharge, and cost of hospitalization. Propensity score matching (1:1) was performed to compare the outcomes among women and men. Results A total of 9,281 patients were included in the current analysis [women = 3,659 (39%); men = 5,622 (61%)]. Comparing women to men, women had lower prevalence of diabetes mellitus (30.6% vs 35.7%, p < .01), heart failure (28.6% vs 30.8%, p = .03), vascular disease (55.5% vs 69.6%, p < .01) and renal failure (18.3% vs 21.2%, p < .01), and higher CHA2DS2VASc score (5 [IQR4‐6] vs 4 [IQR3‐6], p < .01). After propensity‐score matching, women had higher rate of major in‐hospital adverse events (2.8% vs 1.9%; p < .01), and nonhome discharges (11.4% vs 6.7%; p < .01). Additionally, 30‐day readmission rate was higher among women (10% vs 8.6%, p = .03). Conclusion Among hospitalized patients undergoing LAAO, women carry higher risk for major in‐hospital adverse events, nonhome discharge, and 30‐day readmission rates.

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Section: Discussionsupporting

confidence: 93%

Sex‐stratified analysis of the safety of percutaneous left atrial appendage occlusion

Patel

Munir

Kawsara

et al. 2020

Cathet Cardio Intervent

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“…The unexpected nature of EGS limits opportunities for preoperative optimization, leading to high rates of non‐home discharge, months away from home even after discharge, and high rates of hospital encounters, particularly in patients with frailty. Although preoperative prediction models have been proposed to identify patients at high risk for non‐home discharge after surgery, these models do not include frailty assessments and were largely developed for patients undergoing elective surgery . Including frailty screens during the EGS hospitalization can have two benefits.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Lee

Streid

Sturgeon

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Few studies examine the impact of frailty on long-term patient-oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1-year outcomes. DESIGN: Retrospective cohort study using 2008 to 2014 Medicare claims. SETTING: Acute care hospitals. PARTICIPANTS: Patients 65 years or older who received one of the five EGS procedures with the highest mortality burden (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy). MEASUREMENTS: A validated claims-based frailty index (CFI) identified patients who were not frail (CFI < .15), prefrail (.15 ≤ CFI < .25), mildly frail (.25 ≤ CFI < .35), and moderately to severely frail (CFI ≥ .35). Multivariable Cox regression compared 1-year mortality. Multivariable Poisson regression compared rates of post-discharge hospital encounters (hospitalizations, intensive care unit stay, emergency department visit) and home time over 1 year after discharge. All regression models adjusted for age, sex, race, admission from facility, procedure, sepsis, inpatient palliative care delivery, trauma center designation, hospital bed size, and teaching status, and they were clustered by patient and hospital referral region. RESULTS: Among 468 459 older EGS adults, 37.4% were pre-frail, 12.4% were mildly frail, and 3.6% were moderately to severely frail. Patients with mild frailty experienced a higher risk of 1-year mortality compared with non-frail patients (hazard ratio = 1.97; confidence interval [CI] = 1.94-2.01). In the year after discharge, patients with mild and moderate to severe frailty had more hospital encounters compared with non-frail patients (7.8 and 11.5 vs 2.0 per person-year; incidence rate ratio [IRR] = 4.01; CI = 3.93-4.08 vs IRR = 5.89; CI = 5.70-6.09, respectively). Patients with mild and moderate to severe frailty also had fewer days at home in the year after discharge compared with non-frail patients (256 and 203 vs 302 mean days; IRR = .97; CI = .96-.97 vs IRR = .95; CI = .94-.95, respectively). CONCLUSION: Older EGS patients with frailty are at increased risk for poor 1-year outcomes and decreased home time. Targeted interventions for older EGS patients with frailty during the index EGS hospitalization are urgently needed to improve long-term outcomes.

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“…16 Based on prior studies, primary outcome was discharge destination, defined as home or NHD. 2,8 NHD included a rehabilitation facility, skilled nursing facility, nursing home, or long-term acute care facility and was abstracted via chart review.…”

Section: Variables and Outcomesmentioning

confidence: 99%

“…However, risk scores and machine-learning algorithms designed to predict length of stay and discharge destination are not always optimized for ease of use at the point of care. 8 Professional societies including the American Geriatrics Society and American College of Surgeons (ACS) recommended using frailty screens for older adults admitted for surgery to prompt interdisciplinary care teams to effectively preserve functional independence, decrease delirium, and reduce 30-day readmission risk in their admitted patients. 4,[9][10][11] However, less is known about the use of frailty screens in a preoperative setting to predict postdischarge needs.…”

mentioning

confidence: 99%

Association Between Patient‐Reported Frailty and Non‐Home Discharge Among Older Adults Undergoing Surgery

Sokas

Cowan

Dalton

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Identifying surgical patients at risk for discharge to a post‐acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient‐reported frailty screen and non‐home discharge (NHD). DESIGN Prospective cohort. SETTING Urban tertiary academic preoperative evaluation center. PARTICIPANTS Convenience sample of patients aged 60 and older evaluated from November 2018 to August 2019) undergoing one of 14 major elective general and vascular operations with an expected length of stay of 3 days or longer. METHODS Items from the previously validated Fatigue, Resistance, Ambulation, Illnesses, Loss of weight (FRAIL) screen were modified, and patients were queried on fatigue, activity against resistance, ambulation, and weight loss. Multivariable logistic regression adjusting for age and sex was used to determine the association between patient‐reported items and NHD. RESULTS A total of 230 patients were included for analysis. The average age of the cohort was 70.1 (standard deviation = 7.1); 91.7% were White, and 52.4% were female. There were 24 patients (10.4%) who were not discharged home. They were more likely to report fatigue (54% vs 29%; P = .01), weight loss (58% vs 21%; P < .01), and difficulty with activity against resistance (33% vs 7%; P < .01) before surgery. In adjusted analysis, patients who self‐reported frailty (FRAIL screen ≥2) were significantly more likely to have an NHD (odds ratio [OR] = 4.5; 95% confidence interval [CI] = 1.7–11.7; P < .01), as were patients who responded “yes” to any question from the FRAIL screen (OR = 2.5; 95% CI = 1.7–3.5; P < .01). A positive response to difficulty with activity against resistance or recent weight loss showed similar odds of NHD (OR = 7.6; 95% CI = 2.6–23.9; P < .01; and OR = 7.9; 95% CI = 2.9–21.6; P < .01, respectively). Conclusion Patient response to screening questions on the FRAIL screen identified those at highest risk of NHD. The FRAIL screening tool is practical, easy to apply, and could be used during preoperative counseling to identify patients likely to have increased discharge planning needs.

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A Pragmatic Preoperative Prediction Score for Nonhome Discharge After Cardiac Operations

Abstract: We identified preoperative risk factors for NHD after cardiac operations and developed a pragmatic NHD prediction score with high accuracy. Addition of postoperative risk factors for NHD only modestly improved prediction. NHD does not decrease the readmission rate after cardiac operations.

Cited by 19 publications

References 25 publications

Sex‐stratified analysis of the safety of percutaneous left atrial appendage occlusion

Sex‐stratified analysis of the safety of percutaneous left atrial appendage occlusion

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Association Between Patient‐Reported Frailty and Non‐Home Discharge Among Older Adults Undergoing Surgery

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