Discharged to Extended Care Facilities After Cardiovascular Surgery: What is Long-Term Outcome?

MedicalResearch.com Interview with: Dr. James R. Edgerton, MD

Cardiopulmonary Research Science and Technology Institute, Dallas, Texas

MedicalResearch.com: What are the main findings of the study?  

Dr. Edgerton: We can use certain patient factors to determine if a patient will be discharged to extended care facility and to predict if he/she will be successfully discharged from that facility to home.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Edgerton: Elderly patients are frequently more concerned with their quality of life than the quantity of life.  For these patients, predicted mortality at thirty days is not an indicator of successful outcome. In frail patients who require discharge to an extended care facility, 30 day mortality data is not representative of the patient’s outcome at one year.  Patients discharged to an extended care facility frequently do not return to their previous lifestyle.  They have a high (31.5%) one year mortality, low likelihood (55%) of returning to independent living, and at one year post-operatively, only 50% are alive and in their own home.  The fate is worst for those who require LTAC with only 30.8% being alive and at home at one year (rehab (63.6%), SNF (52.3%) .

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Edgerton: Medicine is undergoing a paradigm shift from physician centric to patient centric. When offering a procedure to a patient, the probable outcomes that we offer (such as 30 day mortality) to the patient are inadequate to help them make a decision.   We need to develop predicted outcomes that encompass quality of life. We suggest that “alive and at home at one year” is such an outcome.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Edgerton: This work needs to be expanded to a larger group of patients and validated.

Citation:

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

Edgerton JR, Herbert MA, Mahoney C, Armstrong D, Dewey TM, Holper E,
Roper K, Mack MJ.

Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
Ann Thorac Surg. 2013 Jul 15. pii: S0003-4975(13)00854-0. doi: 10.1016/j.athoracsur.2013.04.041.
[Epub ahead of print]

 

 

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