Decreased activities of daily living at discharge predict mortality and readmission in elderly patients after cardiac and aortic surgery

Abstract

Recently, activities of daily living (ADL) were identified as a prognostic factor among elderly patients with heart disease; however, a specific association between ADL and prognosis after cardiac and aortic surgery is not well established. We aimed to clarify the impact of ADL capacity at discharge on prognosis in elderly patients after cardiac and aortic surgery.This retrospective cohort study included 171 elderly patients who underwent open operation for cardiovascular disease in a single center (median age: 74 years; men: 70%). We used the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to the BI at discharge, indicating a high (BI ≥ 85) or low (BI < 85) ADL status. All-cause mortality and unplanned readmission events were observed after discharge.Thirteen all-cause mortality and 44 all-cause unplanned readmission events occurred during the median follow-up of 365 days. Using Kaplan–Meier analysis, a low ADL status was determined to be significantly associated with all-cause mortality and unplanned readmission. In the multivariable Cox proportional hazard models, a low ADL status was an independent predictor of all-cause mortality and unplanned readmission after adjusting for age, sex, length of hospital stay, and other variables (including preoperative status, surgical parameter, and postoperative course).A low ADL status at discharge predicted all-cause mortality and unplanned readmission in elderly patients after cardiac and aortic surgery. A comprehensive approach from the time of admission to postdischarge to improve ADL capacity in elderly patients undergoing cardiac and aortic surgery may improve patient outcomes.

Impact of the Barthel Index Score and Prognosis on Patients Undergoing Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement

“…In some cases, patients may become bedridden or develop disuse syndrome. 6 They can easily develop decubitus ulcers and infections, including pneumonia and urinary tract infections. 15 In the present study, the 1-year survival rates in the SAVR and TAVR groups were 91.9% and 91.6%, respectively; the 2-year survival rates were 88.2% and 83.1%, respectively.…”

“…3,4 Furthermore, an inability to perform activities of daily living (ADL) at discharge predicts mortality or readmission in older patients with heart disease, 5 or after cardiothoracic surgery. 6 The Barthel Index (BI) is the global standard index for ADL. 7 Several reports have compared the BI as an index of ADL and postoperative outcomes after cardiovascular surgery.…”

Quantifying the Risk for Hospital Readmission When Physical Therapist Discharge Recommendations Are Not Followed

“…Findings from previous studies also suggest that race, socioeconomic status, hospital length of stay, mobility status, activities of daily living performance, and number of acute care therapy visits are associated with readmissions. 5,34,35,[52][53][54][55][56] We did not include these variables in our investigation.…”