Patient Disposition and Long-Term Outcomes After Valve Surgery in Octogenarians

被引:38
作者
Henry, Linda [1 ]
Halpin, Linda [1 ]
Hunt, Sharon [1 ]
Holmes, Sari D. [1 ]
Ad, Niv [1 ]
机构
[1] Inova Heart & Vasc Inst, Falls Church, VA 22042 USA
关键词
HIGH-RISK PATIENTS; CARDIAC-SURGERY; SOCIAL SUPPORT; GREATER-THAN-OR-EQUAL-TO-80; YEARS; PSYCHOSOCIAL FACTORS; MORTALITY; IMPLANTATION; CARE; CATHETERIZATION; FAILURE;
D O I
10.1016/j.athoracsur.2012.04.073
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Valve surgery is performed routinely in octogenarians. This study explored variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival. Methods. Patients 80 years or older who presented for aortic valve or mitral valve surgery from 2002 to 2010 were included. Baseline demographic, perioperative, and long-term outcomes were captured. Disposition was categorized into 2 groups; home (n = 184) or other facility (n = 123). The National Death Index and Social Security Death Index verified deaths. Results. Mean age was 82.9 +/- 2.5; 46% (140 of 307) were female. Discharge location logistic regression, adjusted for gender (odds ratio [OR] = 1.45, p = 0.17) and European System for Cardiac Operative Risk Evaluation score (OR = 1.09, p = 0.10), predicted that older (OR = 1.18, p < 0.001), unmarried (OR = 2.07, p = 0.006) patients with at least 1 major complication (OR = 3.86, p < 0.001) were more likely to be not discharged home. Kaplan-Meier analysis found significantly lower 1- and 2-year (85.8% vs 94.6%, p = 0.009; 80.1% vs 90.3%, respectively, p = 0.01) cumulative survival in patients not discharged home. A multivariate Cox proportional hazards model demonstrated poorer 1- and 2-year survival (hazard ratio [HR] = 2.56, p = 0.04; HR = 2.06, p = 0.05, respectively). Predictors of follow-up mortality for patients not discharged home were length of stay (OR = 1.06, p = 0.03) and any major complication (OR = 6.90, p = 0.002); lower body mass index was marginally significant (OR = 1.12, p = 0.06). The significant predictor for patients discharged home was length of stay (OR = 1.17, p = 0.002). Conclusions. Octogenarians can expect excellent survival after valve surgery. Those not discharged home had poorer long-term survival. Therefore, adequate resources should be secured so sicker patients receive the appropriate level of care.
引用
收藏
页码:744 / 750
页数:7
相关论文
共 40 条
[1]   Association of pulmonary artery catheter use with in-hospital mortality [J].
Afessa, B ;
Spencer, S ;
Khan, W ;
LaGatta, M ;
Bridges, L ;
Freire, AX .
CRITICAL CARE MEDICINE, 2001, 29 (06) :1145-1148
[2]   Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity [J].
Afilalo, Jonathan ;
Mottillo, Salvatore ;
Eisenberg, Mark J. ;
Alexander, Karen P. ;
Noiseux, Nicolas ;
Perrault, Louis P. ;
Morin, Jean-Francois ;
Langlois, Yves ;
Ohayon, Samuel M. ;
Monette, Johanne ;
Boivin, Jean-Francois ;
Shahian, David M. ;
Bergman, Howard .
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2012, 5 (02) :222-U140
[3]  
Agency for Healthcare Research and Quality, 2008, HOSP DISCH HOM HLTH
[4]   Educational levels of hospital nurses and surgical patient mortality [J].
Aiken, LH ;
Clarke, SP ;
Cheung, RB ;
Sloane, DM ;
Silber, JH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 290 (12) :1617-1623
[5]   Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction [J].
Aiken, LH ;
Clarke, SP ;
Sloane, DM ;
Sochalski, J ;
Silber, JH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 288 (16) :1987-1993
[6]   Effects of hospital care environment on patient mortality and nurse outcomes [J].
Aiken, Linda H. ;
Clarke, Sean P. ;
Sloane, Douglas M. .
JOURNAL OF NURSING ADMINISTRATION, 2008, 38 (05) :223-229
[7]   Transcatheter Aortic Valve Implantation: Selection Strategy Is Crucial for Outcome [J].
Al-Attar, Nawwar ;
Himbert, Dominique ;
Descoutures, Fleur ;
Iung, Bernard ;
Raffoul, Richard ;
Messika-Zeitoun, David ;
Brochet, Eric ;
Francis, Fady ;
Ibrahim, Hassan ;
Vahanian, Alec ;
Nataf, Patrick .
ANNALS OF THORACIC SURGERY, 2009, 87 (06) :1757-1763
[8]   Outcomes of cardiac surgery in patients age ≥80 years:: Results from the National Cardiovascular Network [J].
Alexander, KP ;
Anstrom, KJ ;
Muhlbaier, LH ;
Grosswald, RD ;
Smith, PK ;
Jones, RH ;
Peterson, ED .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (03) :731-738
[9]  
[Anonymous], DAT AN SOC THOR SURG
[10]  
[Anonymous], AM ASS CARD PULM REH