Risk of Not Being Discharged Home After Isolated Coronary Artery Bypass Graft Operations

Edgerton, James R.; Filardo, Giovanni; Ryan, W. H.; Brinkman, William T.; Smith, Robert L.; Hebeler, Robert F.; Hamman, Baron L.; Sass, Danielle; Harbor, Jessica P.

doi:10.1016/j.athoracsur.2013.05.042

Cited by 16 publications

(11 citation statements)

References 21 publications

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“…We identified three other significant preoperative factors: congestive heart failure, aortic atherosclerosis, and abnormal heart rhythm, which were correlated with mortality risk after CABG. These three risk components are consistent across various established cardiac surgery risk prediction models 4‐23 . Most importantly, our ASCORE‐C model placed emphasis on the ethnic differences within the local Asian population based upon the higher prevalence of diabetes, congestive heart failure, aortic atherosclerosis and renal impairment in some local population.…”

Section: Discussionsupporting

confidence: 52%

“…Owing to the fact that these scores were based on North American and European populations, they may generate inaccurate predictions for Asian patients. In fact, it is widely reported that the EuroSCORE II had overestimated the postoperative mortality in many recent studies conducted in Europe and Asia and STS scoring system is also not accurate in most Asia centers 7‐23 . Another critical concern is that the laudably low incidence of death after CABG could actually render conventional statistical models inaccurate in prediction if the models employ too many covariates 24 .…”

Section: Introductionmentioning

confidence: 99%

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The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE‐C)

et al. 2020

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Objective The mortality of coronary artery bypass graft surgery (CABG) in Asian patients predicted by Western population‐based risk models is not ideal. We aimed to develop a risk scoring system based on a multiracial Asian patient population to predict early‐stage mortality. Methods A total of 2495 patients who underwent isolated CABG in Singapore from 2009 to 2015 were included to develop a regional scoring system: the regional Asian System for Cardiac Operative Risk Evaluation in CABG (ASCORE‐C). Predictors were identified via a stepwise multiple logistic regression to construct models for 30‐day, 90‐day, and 1‐year cumulative mortality prediction. The optimal cut‐offs of ASCORE‐C risk strata were determined by the multiway χ2 and Interaction Detection decision tree. The performance of ASCORE‐C was compared with European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II and Society of Thoracic Surgeons (STS) score by observed/estimated mortality ratio. Results The observed postoperative 30‐day, 90‐day, and 1‐year cumulative mortality following isolated CABG were 2.6%, 3.3%, and 4.6%, respectively. The ASCORE‐C to predict these three events were constructed with age (>65 years), Malay ethnicity, congestive heart failure, abnormal heart rhythm, aortic atherosclerosis, estimated glomerular filtration rate, peripheral vascular disease, critical preoperative status, and emergency surgery. Tested by three different validation datasets, receiver operating characteristic curve of ASCORE‐C model prediction performed well with the Hosmer‐Lemeshow test. The ASCORE‐C was found to have better predictive accuracy than EuroSCORE II and STS score in CABG mortality prediction, especially for the high‐risk patients. Conclusion The ASCORE‐C system is reliable for early‐stage CABG mortality prediction in a multiracial Asian population.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE‐C)

et al. 2020

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“…Previous studies have identified pre‐operative factors that increases an individual's risk of not being discharged home after cardiac surgery . In a study by Henry et al, advanced age, female gender and concomitant valve/CABG were factors associated with discharge to a location other than home after heart valve surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The authors also found pre‐operative chronic lung disease and STS mortality risk scores as predictors of non‐home discharge. A separate study by Edgerton et al studied the same issue in patients undergoing CABG. STS mortality risk scores >2% was found to be strongly associated with a >22.5% risk of being discharged to a nursing home, rehabilitation facility or long‐term care.…”

Section: Discussionmentioning

confidence: 99%

Discharge disposition of older patients undergoing trans‐catheter aortic valve replacement and its impact on survival

Okoh

Haik

Singh

et al. 2019

Cathet Cardio Intervent

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Background Patients undergoing transcatheter aortic valve replacement (TAVR) are likely to be discharged to a location other than home. We aimed to assess the association between discharge disposition after TAVR and patient survival at 1 year. Methods Patients admitted from home and survived till discharge after TAVR were divided into two groups based on discharge disposition (home discharge vs. non‐home discharge). Pre‐operative factors predicting the odds of not being discharged home were identified by using multivariable logistic regression analysis. Study patients were matched one‐to‐one via a propensity scoring method. Differences in procedural outcomes were compared. Survival of both unmatched and matched pairs was evaluated by using the Kaplan‐Meier method with the Kleine‐Moesch‐Berger stratified log‐rank test. Results Out of 1,160 TAVR patients, 851 were admitted from home and survived till discharge. The incidence non‐home discharge was 19% (n = 159). Factors that were significantly associated with non‐home discharge were older age, non‐transfemoral approach, female sex, frailty status, history of chronic lung disease, pacemaker placement and insulin‐dependent diabetes mellitus. One‐to‐one propensity score matching resulted in 141 patient pairs with similar age, operative risk, frailty and functional status. At 1‐year follow‐up, all‐cause mortality rates were significantly higher in the non‐home group than their home counterparts (18% vs. 3%, P = 0.006; stratified log rank test: P = 0.006). Conclusions A considerable number of TAVR patients are discharged to a location other than home after the procedure. Not being discharged home after TAVR is associated with a high mortality risk at 1 year.

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“…12 Predictive models for NHD have been developed in different specialties including orthopedics, gynecology, cardiac and vascular surgery. [13][14][15][16] The use of these models has been associated with decreased postoperative length of stay, cost savings, and improved patient satisfaction. 12,17,18 There are some models to predict patients at risk for NHD following gastric surgery but none for pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Nomogram to predict non-home discharge following pancreaticoduodenectomy in a national cohort of patients

Nassour

Wang

Christie

et al. 2017

HPB

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Risk of Not Being Discharged Home After Isolated Coronary Artery Bypass Graft Operations

Cited by 16 publications

References 21 publications

The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE‐C)

The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE‐C)

Discharge disposition of older patients undergoing trans‐catheter aortic valve replacement and its impact on survival

Nomogram to predict non-home discharge following pancreaticoduodenectomy in a national cohort of patients

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