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.

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; p_interaction < 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.