• Anuradha Lala, Helena L Chang, Xiaoyu Liu, Eric J Charles, Babatunde A Yerokun, Michael E Bowdish, Vinod H Thourani, Michael J Mack, Marissa A Miller, Patrick T O'Gara, Eugene H Blackstone, Alan J Moskowitz, Annetine C Gelijns, John C Mullen, Lynne W Stevenson, and Cardiothoracic Surgical Trials Network (CTSN) Working Group.
• Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: anu.lala@mountsinai.org.
• J. Thorac. Cardiovasc. Surg. 2021 Dec 1; 162 (6): 17691778.e71769-1778.e7.

ObjectivesTo determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR).MethodsDischarge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed.ResultsNHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P = .006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P < .001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P = .002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P = .03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P = .01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P < .001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P = .03), respectively. QOL did not differ significantly between groups.ConclusionsNHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.Copyright © 2020. Published by Elsevier Inc.

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