Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study

Abstract

ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.SettingAdult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).ParticipantsAdult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.ExposureThe primary exposure variable was the calendar year during the which the index surgery was performed.OutcomeThe primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.ResultsWe analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60–76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.ConclusionsThere was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.

Impact of frailty on outcomes after cardiac surgery

“…Age, ANZROD, type of surgery (CABG, valve, CABG + valve), the urgency of surgery (elective, non-elective), hospital type (public, private), and country (Australia, New Zealand) were entered as xed effects. Variable selection was performed based on previous work in this eld and known associations with mortality in this patient group (10). Results are presented as an odds ratio (OR) with a 95% con dence interval (CI).…”

Extracorporeal Life Support for Cardiogenic Shock in Octogenarians: Single Center Experience

“…NHD is a composite measure with an individual patient-centered outcome, and it is associated with patient disability or impaired organ function, which means they are not allowed to discharge the patients to their homes. In a recent study, NHD after cardiac surgery was found to be 7% [ 21 ] and was associated with decreased overall survival.…”

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery

“…The impact on enhancing recovery and long-term outcomes must incorporate additional patient factors and selection criteria, optimal device utilization to include data on myocardial performance, duration and doses of inotropes [112], the stages of AKI [113], various ventilation tactics and timing, mobility, mortality, rescue and failure to rescue [114], ICU and total LOS, readmissions, as well as patient-reported outcomes [29,115,116 && ]. Areas of burgeoning interest and opportunity also include wearable technologies [117][118][119][120][121], novel digital technologies with intelligent computing algorithms [122], virtual ICUs (where the rare expertise with tMCS may be leveraged via technology) [123], discharge location [124], time at home, remote monitoring [125,126], and cardiac rehabilitation [127,128].…”

“…Areas of burgeoning interest and opportunity also include wearable technologies [117–121], novel digital technologies with intelligent computing algorithms [122], virtual ICUs (where the rare expertise with tMCS may be leveraged via technology) [123], discharge location [124], time at home, remote monitoring [125,126], and cardiac rehabilitation [127,128].…”