Predictors and outcomes of discharge to long-term acute care facilities after cardiac surgery

Objective: An increasing number of patients with significant fi cant comorbidities present for complex cardiac surgery, with a subgroup requiring discharge to long-term acute care facilities. We aim to examine predictors and mortality after discharge to a long-term acute care facility. Methods: From January 1, 2015, to April 30, 2021, all adult cardiac surgeries were queried and patients discharged to long-term acute care facilities were identified. fi Baseline characteristics, procedures, and in-hospital complications were compared between long-term acute care facility and non-long-term - long-term acute care facility charges. Random forest analysis was conducted to establish predictors of discharge to long-term acute care facilities. Kaplan-Meier - Meier survival analysis was used to determine probability of survival over 7 years. Multivariate regression modeling was used to establish predictors of death after long-term acute care facility discharge. Results: Of 29,884 patients undergoing cardiac surgery, 324 (1.1%) % ) were charged to a long-term acute care facility. The long-term acute care facility group had higher rates of urgent/emergency operation (54% % vs 23%; % ; 10% % vs 3%, P < .001) and longer mean cardiopulmonary bypass (167 vs 110 minutes, P < .001). By random forest analysis, emergency/urgent status, longer cardiopulmonary bypass duration, redo surgery, endocarditis, and history of dialysis were most predictive of discharge to a long-term acute care facility. Although non-long-term - long-term acute care facility group demonstrated greater than 95% % survival at 6 months, Kaplan-Meier - Meier survival analysis showed 28% % 6-month mortality the long-term acute care facility cohort. Random forest analysis demonstrated that chronic lung disease and postoperative respiratory complications were significant fi cant predictors of death at 6 months after discharge to a long-term acute care facility. Conclusions: Patients with chronic lung and kidney disease undergoing prolonged procedures are at higher risk to be discharged to long-term acute care facilities ter surgery with worse survival. Efforts to minimize postoperative respiratory complications may reduce mortality after discharge to long-term acute care facilities. Thorac Cardiovasc Surg 2024;168:1155-64)