Department of Surgery, Pennsylvania State University, College of Medicine, Hershey, PA.
Office of Medical Education, The Pennsylvania State University, College of Medicine, Hershey, PA.
Ann Vasc Surg. 2021 Aug;75:55-68. doi: 10.1016/j.avsg.2021.02.026. Epub 2021 Apr 7.
Following a carotid endarterectomy (CEA) procedure, patients are discharged to their homes or other locations than home such as an acute care facility or skilled nursing facility based on their functional status and level of medical attention needed. Decision-making for discharge destination following a CEA to home or nonhome locations is important due to the differences in survival and postoperative complications. While primary outcomes such as mortality and occurrence of stroke following CEA have been extensively studied, there is a paucity of information characterizing outcomes of discharge destination and the factors associated. The purpose of this study was to explore the factors associated with discharge to nonhome destinations after CEA, and outcomes after discharge.
Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified patients who underwent CEA from 2011 to 2018. Patients were divided into two groups based on their discharge destination (home versus nonhome). Univariate and multivariate analysis were performed for preoperative and intraoperative factors associated with different discharge destinations. Postoperative complications associated with discharge to nonhome destinations were analyzed and mortality after discharge from hospital was compared between the 2 groups.
A total of 25,094 patients met the criteria for inclusion in the study, of which 39% were females and 61% were males; median age was 71 years. Twenty four thousand one hundred twenty-five patients (93.13%) were discharged to home (Group I) and 1,779 (6.87%) were discharged to nonhome destinations (Group II). Following preoperative and intraoperative factors were associated with discharge to nonhome locations: older age, diabetes mellitus, functional independent status, transfer from other hospitals, symptomatic status, need for preoperative blood transfusions, severe ipsilateral carotid stenosis, elective CEA, need for intraoperative shunt and general anesthesia (all P< 0.05). Following postoperative complications had statistically significant association with discharge to nonhome destinations: postoperative blood transfusion, pneumonia, unplanned intubation, longer than 48 hours on ventilator, development of stroke, myocardial infarction, deep vein thrombosis, and sepsis (all P< 0.05). Mortality after discharge from hospital was 0.39% (n = 100). Mortality among those who were discharged to home was 0.29% vs. 1.63% for those who were discharged to nonhome locations (P< 0.05).
Majority of the patients after CEA are discharged back to their homes. This study identifies the factors which predispose patients discharged to locations, other than home. Patients who are not discharged home have higher mortality as compared to those who are discharged to their homes.
在颈动脉内膜切除术 (CEA) 手术后，根据患者的功能状态和所需医疗水平，将其出院回家或其他地方，如急性护理机构或熟练护理机构。由于生存和术后并发症的差异，CEA 后出院目的地的决策非常重要。虽然已经广泛研究了 CEA 后的主要结果，如死亡率和中风发生，但出院目的地和相关因素的结果信息却很少。本研究旨在探讨与 CEA 后非家庭出院目的地相关的因素，以及出院后的结果。
我们使用美国外科医师学院国家手术质量改进计划 (ACS-NSQIP) 数据库，确定了 2011 年至 2018 年期间接受 CEA 的患者。根据出院目的地（家庭与非家庭）将患者分为两组。对与不同出院目的地相关的术前和术中因素进行单变量和多变量分析。分析与非家庭出院目的地相关的术后并发症，并比较两组患者出院后的死亡率。
共有 25094 名患者符合纳入研究的标准，其中 39%为女性，61%为男性；中位年龄为 71 岁。24125 名患者（93.13%）出院回家（I 组），1779 名（6.87%）出院到非家庭目的地（II 组）。与非家庭出院地点相关的术前和术中因素包括：年龄较大、糖尿病、功能独立状态、从其他医院转来、有症状、需要术前输血、严重同侧颈动脉狭窄、择期 CEA、需要术中分流和全身麻醉（均 P<0.05）。与非家庭出院目的地相关的术后并发症包括：术后输血、肺炎、计划性插管、呼吸机使用超过 48 小时、中风、心肌梗死、深静脉血栓形成和败血症（均 P<0.05）。出院后死亡率为 0.39%（n=100）。出院回家的患者死亡率为 0.29%，而出院到非家庭地点的患者死亡率为 1.63%（P<0.05）。
CEA 后大多数患者出院回家。本研究确定了导致患者出院到其他地点而非家庭的因素。未出院回家的患者死亡率高于出院回家的患者。
