The Heart Hospital Baylor Plano, Plano, Texas; Cardiopulmonary Research Science and Technology Institute, Medical City Dallas Hospital, Dallas, Texas.
The Heart Hospital Baylor Plano, Plano, Texas; Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas; Department of Statistical Science, Southern Methodist University, Dallas, Texas; Department of Infectious Diseases, University of Louisville, Louisville, Kentucky; Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas.
Ann Thorac Surg. 2013 Oct;96(4):1287-1292. doi: 10.1016/j.athoracsur.2013.05.042. Epub 2013 Aug 21.
The age and risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) is increasing, which will likely increase the proportion of CABG patients discharged to nursing homes, rehabilitation, or long-term care. Because discharge disposition can be important to a patient's treatment goals, developing and using predictive tools will improve informed treatment decision making. We examined the utility of The Society of Thoracic Surgeons (STS) risk of mortality score in predicting discharge disposition after CABG.
From January 1, 2004 to October 31, 2011, 5,119 patients underwent isolated CABG at The Heart Hospital Baylor Plano or Baylor University Medical Center (Texas) and were discharged alive. The association between STS risk of mortality and discharge to nursing home, rehabilitation, or long-term care was assessed using multivariable logistic regression, adjusted for age, body surface area, marital status, site, and year of operation.
At discharge, 216 patients (4.21%) went to nursing homes, 153 (2.99%) to rehabilitation, and 115 (2.25%) to long-term care. The STS risk of mortality score was significantly positively associated with discharge status (p < 0.001). Patients with 1%, 2%, 3%, 4%, and 5% STS risk of mortality had 11.25%, 22.10%, 29.45%, 35.00%, and 38.50% probability, respectively, of not being discharged home. When the STS risk of mortality was 5%, the risk of not being discharged home was 47.9% for off-pump patients and 38.10% for on-pump patients.
STS risk score is strongly associated with CABG discharge status. Patients with a risk score exceeding 2 are at high risk (>22%) of not being discharged home. This risk should be discussed when treatment decisions are being made.
接受单纯冠状动脉旁路移植术（CABG）的患者年龄和风险状况不断增加，这可能会增加 CABG 患者出院到疗养院、康复机构或长期护理机构的比例。由于出院去向对患者的治疗目标可能很重要，因此开发和使用预测工具将有助于做出明智的治疗决策。我们研究了胸外科医生协会（STS）死亡率风险评分在预测 CABG 后出院去向方面的作用。
2004 年 1 月 1 日至 2011 年 10 月 31 日，5119 名患者在贝勒普兰诺心脏医院或贝勒大学医学中心（德克萨斯州）接受单纯 CABG 手术并存活出院。使用多变量逻辑回归评估 STS 死亡率风险与疗养院、康复机构或长期护理机构出院的相关性，调整因素包括年龄、体表面积、婚姻状况、手术部位和手术年份。
出院时，216 名患者（4.21%）去疗养院，153 名（2.99%）去康复机构，115 名（2.25%）去长期护理机构。STS 死亡率评分与出院状态显著正相关（p<0.001）。STS 死亡率为 1%、2%、3%、4%和 5%的患者，其不能出院回家的概率分别为 11.25%、22.10%、29.45%、35.00%和 38.50%。当 STS 死亡率为 5%时，非心脏停搏患者不能出院回家的风险为 47.9%，而心脏不停搏患者的这一风险为 38.10%。
STS 风险评分与 CABG 出院状态密切相关。风险评分超过 2 的患者不能出院回家的风险较高（>22%）。在做出治疗决策时，应讨论这一风险。
