Long-Term Fate of Patients Discharged to Extended Care Facilities After Cardiovascular Surgery

Edgerton, James R.; Herbert, Morley A.; Mahoney, Cecile; Armstrong, Drew; Dewey, Todd M.; Holper, Elizabeth M.; Roper, Karen L.; Mack, Michael J.

doi:10.1016/j.athoracsur.2013.04.041

Cited by 62 publications

(49 citation statements)

References 8 publications

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“…The majority of subjects of both groups were able to be discharged home (Table 2). Our results are in agreement with those of a single-hospital, retrospective study, 38 which followed 590 cardiac surgery subjects for at least 1 y after discharge. At hospital discharge, 84.4% of subjects went home, 3.7% to rehabilitation program, 7.5% to skilled nursing facilities, and 4.4% to a longterm acute care facility.…”

Section: Discussionsupporting

confidence: 82%

Outcomes for Difficult-to-Wean Subjects After Cardiac Surgery

et al. 2014

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BACKGROUND:The need for prolonged mechanical ventilation (PMV) after cardiac surgery is still a common problem. We hypothesized that subjects who required PMV after a single surgery (either coronary artery bypass grafting or valve surgery) would have better outcomes than those who had experienced both revascularization and valve surgery. METHODS: We retrospectively analyzed the characteristics and outcomes for patients consecutively admitted to our weaning unit (WU) after cardiac surgery between December 2007 and August 2012. Subjects' data were analyzed according to the number of procedures. Group 1 included subjects who had undergone a single surgery (valvular replacement or myocardial revascularization). Group 2 included subjects who had undergone combined surgery (valvular replacement and myocardial revascularization). Data for PMV subjects who were transferred to the WU for reasons other than cardiac surgery in the same period are also reported. RESULTS: Of 584 PMV subjects admitted, 35 (5.9%, 19 in group 1 and 16 in group 2) were referred after cardiac surgery. At WU admission, group 2 showed significantly more comorbidities and a greater clinical severity than group 1. Compared with group 1, group 2 showed a significantly lower weaning rate (43.7% vs 78.9%, P ‫؍‬ .003) and a higher in-hospital mortality (31.3% vs 5.3%, P ‫؍‬ .04). The overall 6-month survival for subjects of group 1 was 73.7% compared with 37.5% for subjects in group 2 (P ‫؍‬ .02). Adjusting for comorbidities and clinical severity, the difference between the 2 groups did not reach statistical significance for either the weaning rate or the overall 6-month survival. At discharge, health status, as assessed by means of functional independence measure, was significantly better in group 1 than in group 2 (P ‫؍‬ .035). CONCLUSIONS: These results suggest that patients needing PMV after combined cardiac surgery may suffer worse outcomes than those needing PMV after simple cardiac surgery.

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Section: Discussionsupporting

confidence: 82%

Outcomes for Difficult-to-Wean Subjects After Cardiac Surgery

et al. 2014

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“…In our cohort, discharge to home from index hospitalization was 73% (27% to other facility) and readmission within 30 days of procedure for any cause was 18.9%. Our group has previously published data demonstrating a higher rate of survival of patients discharged to home as compared to another health care facility after cardiac surgery . Although our study does not look at outcomes by where the patients are discharged, and there are no data on discharge location and TAVR outcomes, one could extrapolate from the above data that discharge to home in these patients is better than discharge to a facility other than home.…”

Section: Discussionmentioning

confidence: 91%

The outcomes of transcatheter aortic valve replacement in a cohort of patients with end‐stage renal disease

Kim

Adeniyi

Thourani

et al. 2016

Cathet Cardio Intervent

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Objectives: To examine whether transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for aortic stenosis in patients with end-stage renal disease (ESRD). Background: Patients with ESRD undergoing surgical aortic valve replacement have an operative mortality approaching 20% and a 10-year survival of approximately 12%. We investigated whether TAVR is a more reasonable option. Methods: This is a multicenter, retrospective study of all patients with ESRD who underwent TAVR in 8 institutions between 12/2011 and 02/2013. Demographic characteristics, (2016) mortality, major, and minor complications were evaluated. Outcomes were stratified by operative approach. Results: Forty-three patients with a mean age 76.2 6 11.0 years and a mean STS predicted risk of mortality of 15.53 6 8.70% underwent TAVR. Mean duration of dialysis was 45.2 6 52.3 months (median 29.5 months). Transfemoral (TF) TAVR was performed in 31/43 (72.1%), transapical in 11/43 (25.6%), and transaortic in 1/ 43 (2.3%). Operative mortality was 14.0% (6/43) with TF mortality 6.5% (2/31) and 33.3% (4/12) in non-TF patients. Six-month mortality was 11/43 (25.6%: 16.1% TF, 50.0% non-TF). Complications included stroke in 2.3% (1/43) and life-threatening or major bleeding in 14.0% (6/43). Discharge to another healthcare facility was 27.0% (10/37). Readmission within 30 days of procedure for any cause was 18.9% (7/37). Conclusions: Patients with ESRD who undergo TAVR are at high risk for mortality and complications. TAVR outcomes are comparable to but not substantially better than those with SAVR. Transfemoral TAVR seems to be at least as safe and effective as the current standard SAVR in patients undergoing aortic valve replacement. V C 2016 Wiley Periodicals, Inc.

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“…Importantly, the majority of patients were discharged to home. Our group has previously reported a higher rate of survival of patients discharged to home as compared with discharge to another healthcare facility after cardiac surgery [22]. The high rate of discharge to home after TAVR demonstrates the ability of carefully selected nonagenarians to recover from TAVR procedures.…”

Section: Commentmentioning

confidence: 86%