TY - JOUR
T1 - Risk for non-home discharge following surgery for ischemic mitral valve disease
AU - Cardiothoracic Surgical Trials Network (CTSN) Working Group
AU - Lala, Anuradha
AU - Chang, Helena L.
AU - Liu, Xiaoyu
AU - Charles, Eric J.
AU - Yerokun, Babatunde A.
AU - Bowdish, Michael E.
AU - Thourani, Vinod H.
AU - Mack, Michael J.
AU - Miller, Marissa A.
AU - O'Gara, Patrick T.
AU - Blackstone, Eugene H.
AU - Moskowitz, Alan J.
AU - Gelijns, Annetine C.
AU - Mullen, John C.
AU - Stevenson, Lynne W.
AU - DeRose, Joseph J.
AU - Wang, Alice
AU - Smith, Peter K.
AU - Acker, Michael A.
AU - Ailawadi, Gorav
AU - Taddei-Peters, Wendy C.
AU - Buxton, Dennis
AU - Caulder, Ron
AU - Geller, Nancy L.
AU - Gordon, David
AU - Jeffries, Neal O.
AU - Lee, Albert
AU - Gombos, Ilana Kogan
AU - Ralph, Jennifer
AU - Weisel, Richard D.
AU - Gardner, Timothy J.
AU - Rose, Eric A.
AU - Parides, Michael K.
AU - Ascheim, Deborah D.
AU - Bagiella, Emilia
AU - Moquete, Ellen
AU - Chang, Helena
AU - Chase, Melissa
AU - Foo, James
AU - Chen, Yingchun
AU - Goldfarb, Seth
AU - Gupta, Lopa
AU - Kirkwood, Katherine
AU - Dobrev, Edlira
AU - Levitan, Ron
AU - O'Sullivan, Karen
AU - Overbey, Jessica
AU - Santos, Milerva
AU - Kron, Irving L.
AU - Bull, David A.
N1 - Publisher Copyright:
© 2020
PY - 2021/12
Y1 - 2021/12
N2 - Objectives: To determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR). Methods: Discharge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed. Results: NHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P =.006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P <.001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P =.002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P =.03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P =.01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P <.001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P =.03), respectively. QOL did not differ significantly between groups. Conclusions: NHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.
AB - Objectives: To determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR). Methods: Discharge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed. Results: NHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P =.006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P <.001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P =.002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P =.03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P =.01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P <.001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P =.03), respectively. QOL did not differ significantly between groups. Conclusions: NHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.
KW - mitral regurgitation
KW - mitral valve disease
KW - non-home discharge
KW - postoperative SAE
KW - quality of life
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U2 - 10.1016/j.jtcvs.2020.02.084
DO - 10.1016/j.jtcvs.2020.02.084
M3 - Article
C2 - 32307181
AN - SCOPUS:85083258017
SN - 0022-5223
VL - 162
SP - 1769-1778.e7
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -