Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study

Non-home discharge after cardiac surgery in Australia and New Zealand: a cross-sectional study

OBJECTIVE

To determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).

DESIGN

Retrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.

SETTING

Adult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).

PARTICIPANTS

Adult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.

EXPOSURE

The primary exposure variable was the calendar year during the which the index surgery was performed.

OUTCOME

The primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.

RESULTS

We analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60-76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.

CONCLUSIONS

There was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.

[Influencing factors for nursing home admission in case of pre-existing need of care - a systematic review]

INTRODUCTION

Knowledge about predictors of nursing home placement is highly relevant. If they are known, targeted interventions such as counselling can help prevent or delay relocation to a nursing home. Above all, preventive and structural measures can target influenceable predictors. The aim of the review was to map predictors of nursing home admission and thus the permanent stay in inpatient long-term care for the target group of people with a pre-existing need for care.

METHODS

A systematic literature search in the databases The Cochrane Library, PubMed, CINAHL, GeroLit and CareLit® was conducted in September 2017. Longitudinal studies with quantitative analyses were included. The methodological quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

45 cohort studies were included. 21 studies examined study populations with need for care, in 24 studies the care status was unclear. A variety of predictors of nursing home admission with at least one-and-a-half times higher risk for both study populations could be identified, including higher age, dementia, underweight, higher age of caregiver, psychiatric symptoms, smoking status, ethnicity, challenging behaviour in people with dementia, higher number of hospitalizations and lower level of life satisfaction.

DISCUSSION

All the predictors identified are relevant to people in need of care. No predictors for the study population with need of care could be identified that are particularly important in contrast to persons with an unclear care status. However, the quality of studies among people with care and support needs is limited compared to studies targeting people with unclear care status.

CONCLUSIONS

Many factors seem to predict the admission to a nursing facility. For the first time, these factors are listed in this systematic review for the target group of people in need of care. Interventions or preventive measures based on known influenceable predictors can help prevent or delay nursing home admission.

Return to the workforce following infective endocarditis-A nationwide cohort study

BACKGROUND

The ability to return to work after infective endocarditis (IE) holds important socioeconomic consequences for both patients and society, yet data on this issue are sparse. We examined return to the workforce and associated factors in IE patients of working age.

METHODS

Using Danish nationwide registries, we identified 1,065 patients aged 18-60 years with a first-time diagnosis of IE (1996-2013) who were part of the workforce prior to admission and alive at discharge.

RESULTS

One year after discharge, 765 (71.8%) patients had returned to the workforce, 130 (12.2%) were on paid sick leave, 76 (7.1%) received disability pension, 23 (2.2%) were on early retirement, 65 (6.1%) had died, and 6 (0.6%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression. Younger age (18-40 vs 56-60 years; odds ratio, 2.85; 95% CI, 1.71-4.76) and higher level of education (higher educational level vs basic school; 5.47, 2.05-14.6) and income (highest quartile vs lowest; 3.17, 1.85-5.46) were associated with return to the workforce. Longer length of hospital stay (>90 vs 14-30 days; 0.16, 0.07-0.38); stroke during IE admission (0.38, 0.21-0.71); and a history of chronic kidney disease (0.29, 0.11-0.75), chronic obstructive pulmonary disease (0.31, 0.13-0.71), and malignancy (0.39, 0.22-0.69) were associated with a lower likelihood of returning to the workforce.

CONCLUSIONS

Seven of 10 patients who were part of the workforce prior to IE and alive at discharge were part of the workforce 1 year later. Younger age, higher socioeconomic status, and absence of major comorbidities were associated with return to the workforce.

Return to the workforce following coronary artery bypass grafting: A Danish nationwide cohort study

BACKGROUND

Returning to the workforce after coronary artery bypass grafting (CABG) holds important socioeconomic consequences not only for patients, but the society as well. Yet data on this issue are limited. We examined return to the workforce and associated factors in patients of working age undergoing CABG.

METHODS AND RESULTS

Using Danish nationwide administrative registries, we identified 6031 patients of working age (18-60years) undergoing isolated CABG (1998-2011) who were part of the workforce 30days prior to admission and alive at discharge. One year after discharge for CABG, 4827 (80.0%) patients had returned to the workforce, 614 (10.2%) were on paid sick leave, 267 (4.4%) received disability pension, 250 (4.1%) were on early retirement, 57 (0.9%) had died, and 16 (0.3%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression. Younger age (18-45 versus 56-60years; odds ratio, 1.89; 95% confidence interval, 1.48-2.42), male sex (1.51, 1.24-1.84), and higher level of education (higher educational level versus basic school; 1.53, 1.05-2.23) and income (highest quartile versus lowest; 3.01, 2.42-3.75) were associated with return to the workforce. Urgency of surgery (emergency versus elective; 0.65, 0.49-0.88), cardiovascular comorbidity, a history of chronic kidney disease (0.49, 0.29-0.84) and liver disease (0.47, 0.28-0.80), as well as additional hospital admissions within the first year post-discharge (>2 versus none; 0.25, 0.19-0.32) were associated with a lower likelihood of returning to the workforce.

CONCLUSION

One year after discharge for CABG, four out of five patients were part of the workforce and mortality was low. Younger age, male sex, higher socioeconomic status, and absence of major comorbidities were associated with return to the workforce.