A Pragmatic Preoperative Prediction Score for Nonhome Discharge After Cardiac Operations.

Area of Science:

• Cardiovascular Surgery
• Quality Improvement
• Health Outcomes Research

Background:

• Nonhome discharge (NHD) after cardiac operations presents a quality improvement opportunity.
• Identifying patients at high risk for NHD is essential for targeted interventions.

Purpose of the Study:

• To identify primary predictors of NHD after cardiac operations.
• To develop a robust preoperative prediction tool for NHD risk.
• To assess the impact of NHD on 30-day hospital readmission.

Main Methods:

• Retrospective review of 5,253 cardiac surgery patients (2012-2016).
• Development of two NHD prediction models: preoperative and combined pre/postoperative.
• Multivariable logistic regression analysis to identify predictors and assess model performance (AUC, R²).

Main Results:

• A preoperative model accurately predicted NHD using age, sex, marital status, obesity, comorbidities, addictions, psychiatric disease, and planned operation (AUC=0.820).
• Inclusion of postoperative factors (LOS, neurologic events) modestly improved prediction (AUC=0.860).
• Patients with NHD had higher readmission rates (16% vs 11%).

Conclusions:

• Preoperative risk factors can accurately predict NHD after cardiac surgery.
• Postoperative factors offer only a modest improvement in NHD prediction.
• NHD does not decrease, and may increase, 30-day readmission rates.