Key result
Living alone linked to ~19% higher odds of prolonged hospital stay after cardiac surgery.
Why the study?
Risk after cardiac surgery is traditionally attributed to biological and physiological processes, but emotional, behavioral, social, and functional factors may also predict poor outcomes.
Does living alone and other psychosocial or patient-reported measures predict worse clinical outcomes in adults undergoing cardiac surgery, supplementing EuroSCORE?
Cohort (n=3,217)
Yes
Does living alone and other psychosocial or patient-reported measures predict worse clinical outcomes in adults undergoing cardiac surgery, supplementing EuroSCORE?
Odds Ratio: 1.19 (95% CI 1.02–1.38)
Social factors such as living alone and impaired health-related quality of life meaningfully supplement traditional clinical risk models like EuroSCORE in predicting adverse postoperative outcomes in cardiac surgery patients.
Living alone was associated with prolonged stay after cardiac surgery; extends EuroSCORE prediction but hypothesis-generating and requires prospective validation.
OBJECTIVES: The risk of poor outcomes is traditionally attributed to biological and physiological processes in cardiac surgery. However, evidence exists that other factors, such as emotional, behavioral, social, and functional, are predictive of poor outcomes. Objectives were to evaluate the predictive value of several emotional, social, functional, and behavioral factors on four outcomes: death within 90 days, prolonged stay in intensive care, prolonged hospital admission, and readmission within 90 days following cardiac surgery. METHODS: This prospective study included adults undergoing cardiac surgery 2013-2014, including information on register-based socioeconomic factors and self-reported health in a nested subsample. Logistic regression analyses to determine the association and incremental value of each candidate predictor variable were conducted. Multiple regression analyses were used to determine the incremental value of each candidate predictor variable, as well as discrimination and calibration based on the area under the curve (AUC) and Brier score. RESULTS: Of 3217 patients, 3% died, 9% had prolonged intensive care stay, 51% had prolonged hospital admission, and 39% were readmitted to hospital. Patients living alone (odds ratio, 1.19; 95% confidence interval, 1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low health-related quality of life (1.43; 1.02-2.01) had prolonged hospital admission. Analyses revealed living alone as predictive of prolonged intensive care unit (ICU) stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71), and prolonged hospital admission (0.24; 0.62). CONCLUSION: Living alone was found to supplement EuroSCORE in predicting death, prolonged hospital admission, and prolonged ICU stay following cardiac surgery. Low educational level and impaired health-related quality of life were, furthermore, predictive of prolonged hospital admission.
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Cromhout et al. (2020) conducted a cohort in Adults undergoing cardiac surgery (n=3,217). Living alone vs. Living with a spouse or partner was evaluated on Prolonged hospital admission (≥10 days) (OR 1.19, 95% CI 1.02-1.38). Living alone increased the odds of prolonged hospital admission by 19% (OR 1.19) compared to living with a partner following cardiac surgery.
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