Abstract 66: Predictors And Long-term Outcomes Of Skilled Nursing Facility Use After Cardiac Surgery: Insights From Michigan

Background: Payment reform efforts have sought to minimize the use of skilled nursing facilities (SNF) after coronary artery bypass grafting (CABG). Little is known about the characteristics and long-term consequences of CABG patients that are discharged to SNF. The purpose of this study was to identify clinical predictors and long-term outcomes associated with SNF use after isolated CABG. Methods and Results: Clinical data from the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were linked to Medicare fee-for-service claims for 8280 Michigan residents undergoing isolated CABG that had no prior SNF use and were discharged alive between 7/1/2012-12/31/2018. A total of 1876 patients (22.7%) had any SNF use identified in claims within one year of discharge with a mean of 27.1 SNF days (SD=30.2). Mean Society of Thoracic Surgeons calculated preoperative risk of mortality was higher for SNF users compared to non-users (3.6% vs 2.0%, p<0.001). Among the 2471 patients with a five-meter walk test, SNF users had a significantly longer five-meter walk time (7.4 vs 6.0 seconds, p<0.001). Multivariable logistic regression identified several factors associated with SNF use, including female sex, older age, non-white race, urgent admission, and the presence of comorbid conditions and major operative morbidity. Long-term survival was significantly worse for SNF users (log-rank test p<0.001) with Kaplan-Meier estimated 5-year survival at 66% versus 86% for non-SNF users (Figure). Even after risk adjustment, hazard ratio of mortality associated with SNF use was 2.04 (95% CI: 1.81-2.29, p<0.001). Conclusions: One in five isolated CABG patients in Michigan used SNF within a year of discharge and represented a demographically and clinically distinct population of patients with worse long-term survival. Efforts to reduce SNF use following CABG could result in serious unintended effects on outcomes in this at-risk population.