Skilled Care Requirements for Elderly Patients After Coronary Artery Bypass Grafting

Objectives: To examine the extent to which elderly individuals use various skilled care facilities after coronary artery bypass grafting (CABG). Design: Retrospective cohort study. Setting: State of Michigan from 1997 to 1998. Participants: Residents aged 65 and older enrolled in Medicare who underwent CABG. Measurements: Cumulative incidence of admission within 100 days of hospital discharge, relative risk (RR) of admission, readmission or extended stay at a skilled care facility, and length of stay in a skilled care facility. Results: Fifty percent of patients aged 80 and older used a skilled care facility after CABG, with most requiring admission to a skilled nursing facility (SNF) or readmission to an acute-care hospital within 100 days after discharge. Patients aged 80 and older had a significantly higher risk of admission to a SNF (adjusted RR=3.3, 95% confidence interval (CI)=2.8?4.0) than did those aged 65 to 69, as did patients aged 75 to 79 (adjusted RR=2.2, 95% CI=1.8?2.6) and those aged 70 to 74 (adjusted RR=1.5, 95% CI=1.3?1.8). The length of time spent in skilled care facilities significantly increased with age (mean days=13.3 for aged 65?69, 16.9 for 70?74, 19.6 for 75?79, and 22.9 for 80 and older; P<.001). Conclusion: Older patients are more likely to be admitted to a SNF, be readmitted to an acute-care hospital, and have longer institutional stays after CABG. When balancing the risks and benefits of CABG, physicians, patients, families, and policy-makers need to carefully consider the likelihood of follow-up institutional care in elderly patients.