Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA.
Ann Thorac Surg. 2013 Sep;96(3):871-7. doi: 10.1016/j.athoracsur.2013.04.041. Epub 2013 Jul 16.
The Society of Thoracic Surgeons predictive algorithms can be used to help patients understand the risks in having a surgical procedure. However, elderly patients are frequently more concerned about the quality of their remaining life and whether they will return home. Currently, we have no predictors of which patients are likely to return to independent living after surgery. We followed patients discharged home or to an extended care facility to determine which patients were most likely to return home and be alive at one year.
This single-hospital, retrospective study followed 590 cardiac surgery patients (January 2008 to December 2009) for at least 1 year after discharge. Follow-up data were collected by contacting facilities, patients, and families, and Social Security Death Index searches.
At hospital discharge, 84.4% went home, 3.7% to rehab, 7.5% to skilled nursing facilities (SNF), and 4.4% to a long-term acute care facility (LTAC). Predictors for facility discharge include increasing age, female, dialysis, emergent status, procedures other than CAB, preoperative stroke, and moderate to severe tricuspid insufficiency. The most significant predictors of dying or still being in a facility at 1 year include being on dialysis, right heart failure, and having chronic lung disease. Considering perioperative complications, requiring prolonged ventilation decreases the odds of being home and alive at 1 year by 67%: one-year survival at home, 95.4%; rehabilitation, 63.6%; SNF, 52.3%; and LTAC, 30.8%.
Many patients discharged to extended care do not return to their previous lifestyle; only 30.8% of those requiring care in a LTAC facility are alive at home at 1 year.
胸外科医师协会的预测算法可用于帮助患者了解手术风险。然而，老年患者通常更关心剩余生命的质量以及他们是否能回家。目前，我们还没有预测哪些患者在手术后可能恢复独立生活的指标。我们跟踪出院回家或入住长期护理机构的患者，以确定哪些患者最有可能回家并在一年后存活。
这是一项单中心回顾性研究，对 2008 年 1 月至 2009 年 12 月期间出院的 590 名心脏手术患者进行了至少 1 年的随访。通过联系医疗机构、患者和家属以及社会保障死亡索引搜索来收集随访数据。
出院时，84.4%的患者回家，3.7%去康复中心，7.5%去养老院，4.4%去长期急性护理机构。机构出院的预测因素包括年龄增加、女性、透析、紧急状态、除冠状动脉旁路移植术以外的手术、术前中风和中重度三尖瓣关闭不全。在 1 年时死亡或仍在机构中的最显著预测因素包括透析、右心衰竭和慢性肺部疾病。考虑到围手术期并发症，需要长时间通气会使 1 年时在家并存活的几率降低 67%：在家中 1 年的生存率为 95.4%；康复中心为 63.6%；养老院为 52.3%；长期急性护理机构为 30.8%。
许多出院到长期护理机构的患者无法恢复以前的生活方式；在需要长期急性护理机构护理的患者中，只有 30.8%在 1 年后仍在家中存活。
