Abstract P336: Are Post-Operative Length-of-Stay and Rehospitalization Linked to Caregiving among Cardiac Surgery Patients?
Background: Cardiac surgery patients are frequently cared for by family members or paid aides, potentially impacting clinical outcomes, yet data are sparse. The purpose of this study was to evaluate the association between access to paid or informal (unpaid) caregiving among cardiac surgery patients and post-operative length-of-stay, and death or rehospitalization at 1 year.
Methods: We prospectively studied 665 consecutive patients admitted for cardiac surgery at a university hospital as part of a NHLBI-sponsored clinical outcomes study (93% participation rate). Participants (mean age 65 years; 35% female; 21% minority) completed an interviewer-assisted questionnaire at baseline to determine if they had a caregiver and the extent of care received. A hospital-based clinical information system was used to document post-operative length-of-stay and death or rehospitalization at 1 year (supplemented by standardized questionnaire). Demographics and comorbid conditions were documented by electronic chart assessment; comorbidity score was calculated using the Ghali comorbidity index. Associations between caregiving and clinical outcomes were evaluated by multiple logistic regression, adjusted for demographics (age, race, sex, marital status, health insurance) and comorbid conditions.
Results: At baseline, 28% (183/665) of cardiac surgery patients reported having a caregiver (8% paid; 20% informal only). Having a caregiver was significantly associated with longer (>7 days) post-operative length-of-stay (OR=1.86; 95%CI=1.30−2.65). This association varied by whether patients had a paid (OR=3.00; 95%CI=1.57−5.74) or informal caregiver (OR=1.55; 95%CI=1.04−2.31) versus none and was attenuated after multivariable adjustment (paid caregiver OR=2.15; 95%CI=1.02−4.52, informal caregiver OR=1.23;95%CI=0.78−1.95). Having a paid caregiver was significantly associated with death or rehospitalization at 1 year in univariate analysis (OR=2.09; 95%CI=1.18−3.69) and was significantly attenuated after multivariable adjustment (OR=1.40; 95%CI=0.74−2.62). There was a non-significant univariate association between having an informal caregiver and death or rehospitalization at 1 year (OR=1.39; 95%CI=0.94−2.06).
Conclusions: Cardiac surgery patients who identified having a caregiver had longer post-operative stays and a higher rate of death or rehospitalization at 1 year compared to those without a caregiver, not fully explained by comorbidities/confounders. These data suggest that assessment of caregiver status may be a powerful predictor and a simple method to identify cardiac surgery patients at risk for adverse clinical outcomes.
- © 2012 by American Heart Association, Inc.