Disparities in Skilled Nursing Facility Use and Outcomes After Cardiac Surgery

Cardiac surgery remains highly morbid and requires significant postoperative care. The use of postacute care facilities, such as skilled nursing facilities (SNFs) has grown in popularity to reduce healthcare spendings. Currently, sex and race disparities associated with SNF use after cardiac surgery are poorly understood.

Patients who underwent coronary artery bypass graftingfrom June 2016 to December 2018 were identified in Medicare Provider Analysis and Review data. Patients were stratified into 4 groups based on sex and race as follows: White male, White female, Black male, and Black female. The impact of sex and race on SNF use and the associated outcomes were evaluated using logistic regression and Cox-proportional hazards analysis.

Of the 93,727 patients who underwent coronary artery bypass grafting, 67,244 (71.7%) were White males, 2517 (2.7%) were Black males, 22,187 (23.7%) were White females, and 1779 (1.9%) were Black females. Black female patients (37.1%) were most likely to be discharged to SNF, followed by White females (33.7%), Black males (24.9%), and White males (18.9%) (P < 0.001). After adjustment, Black males (OR = 1.34, 95% CI: 1.21-1.49), White females (OR = 1.82, 95% CI: 1.75-2.13), and Black females (OR = 1.90, 95% CI: 1.70-2.13) were more likely to be discharged to SNF compared to White males. However, of the patients discharged to SNF, only White females and Black females had better overall survival when compared to White men.

Significant disparities in the use of SNF after cardiac surgery are present across sex and race categories; however, the 1-y mortality benefit after risk adjustment does not reflect these differences.