Predictors & Outcomes of Discharge to Long-Term Acute Care Facilities after Cardiac Surgery

OBJECTIVE:An increasing number of patients with significant comorbidities present for complex cardiac surgery, with a subgroup requiring discharge to long-term acute care facilities (LTAC). We aim to examine predictors and mortality after discharge to LTAC. METHODS:From 1/01/2015 to 4/30/2021, all adult cardiac surgeries were queried and patients discharged to LTAC were identified. Baseline characteristics, procedures, and in-hospital complications were compared between LTAC and non-LTAC discharges. Random forest analysis was conducted to establish predictors of discharge to LTAC. Kaplan-Meier survival analysis was used to determine probability of survival over 7-years. Multivariate regression modeling was used to establish predictors of death following LTAC discharge. RESULTS:Of 29,884 patients undergoing cardiac surgery, 324 patients (1.1%) were discharged to LTAC. The LTAC group had higher rates of urgent/emergency operation (54% vs 23%; 10% vs 3%, p<0.001) and longer mean cardiopulmonary bypass (167min vs 110min, p<0.001). By random forest analysis, emergency/urgent status, longer cardiopulmonary bypass duration, redo surgery, endocarditis, and history of dialysis were the most predictive of discharge to LTAC. While the non-LTAC group demonstrated >95% survival at 6 months, Kaplan-Meier survival analysis showed 28% 6-month mortality among the LTAC cohort. Random forest analysis demonstrated that chronic lung disease and postoperative respiratory complications were significant predictors of death at 6 months after discharge to LTAC. CONCLUSIONS:Patients with chronic lung and kidney disease undergoing prolonged procedures are at higher risk to be discharged to LTAC after surgery with worse survival. Efforts to minimize postoperative respiratory complications may reduce mortality after discharge to LTAC.