Discharge to Nonhome Locations and Association With Long-term Survival After Cardiac Surgery in Australia and New Zealand Intensive Care Units: A Retrospective Multicenter Cohort Study.
Catherine Bartlett, Ryan Ruiyang Ling, Ashwin Subramaniam, David Pilcher, Mahesh Ramanan
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引用次数: 0
Abstract
Objectives: Nonhome discharge (NHD) after cardiac surgery has increased in Australia and New Zealand, but its effect on long-term survival is unclear. This study aimed to assess whether NHD, compared with home discharge (HD), was associated with decreased survival up to 4 years after surgery. Additional objectives included evaluating the effects of discharge location, age, surgery types, and emergency status on long-term survival.
Design: We conducted a retrospective, multicenter, registry-based study (2018-2023).
Setting: We included 74 intensive care units (ICUs) across Australia and New Zealand that submitted data to the Australia New Zealand Intensive Care Society Adult Patient Database.
Participants: Adults (≥16 years) who underwent valvular surgery, coronary artery bypass grafting, or both and survived hospital discharge.
Interventions: None.
Measurements and main results: The study involved 92,865 patients, of whom 13,444 (14.5%) experienced NHD. NHD locations comprise rehabilitation centers, aged care facilities, mental health units, acute hospitals, and other settings. Survival up to 4 years was analyzed using Cox proportional hazards models. NHD was associated with reduced survival compared with HD (hazard ratio, 1.91; 95% confidence interval, 1.75-2.09), with the strongest association within the first 12 months after discharge. The association between NHD and reduced survival was notably greater for patients younger than 65 years (hazard ratio, 2.58; 95% confidence interval, 2.20-3.03) compared with those 65 years or older (hazard ratio, 1.71; 95% confidence interval, 1.54-1.89; pinteraction < 0.001). No significant differences existed between the NHD locations. Survival rates after NHD, compared with HD, were lower across all included surgery types, including emergency and elective procedures.
Conclusions: NHD after cardiac surgery is associated independently with decreased long-term survival, with the highest risk observed within the first year.
期刊介绍：
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
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