Validation of Non-Home Discharge Risk Score After Elective Infrainguinal Bypass Surgery.

Abstract

Objective: Non-home discharge (NHD) contributes to poor patient quality of life and healthcare costs. Prior Vascular Study Group of New England database-based analysis developed a novel risk score, outlined in Table 1, for NHD following infrainguinal lower extremity bypass (LEB). Still, it has yet to be validated in an external dataset. This study hypothesized that the LEB NHD risk score would be externally validated using unique single institutional data.

Methods: A single institutional quaternary center electronic data warehouse was queried for elective LEB cases from 2012-2020. The primary endpoint was NHD, defined as discharge to a skilled nursing facility or acute rehabilitation center. This analysis excluded inpatient deaths. A previously developed risk score was applied (table 1). The risk score's predictive ability for NHD was assessed using a logistic regression, c-statistic, and Hosmer-Lemeshow test. The risk score was then categorized as low risk (score <5), moderate risk (score 5-9), and high risk (score >9) for NHD.

Results: Among 242 included patients, NHD occurred in 22% of cases. The mean age of this cohort was 69. The cohort was 38% female and 26.4% non-white. The NHD proportion by risk category was 34% in high-risk, 26% in moderate-risk, and 4% in low-risk cases. High-risk cases represented 17% of the population and 27% of all NHD. On logistic regression, higher-risk groups had significantly higher odds of NHD than the low-risk category (moderate risk OR:8.8, CI 2.02-38.4, p=0.004, high risk OR: 13.0, CI:2.7-63.1, p=0.001). The risk score successfully predicted NHD with a c-statistic of 0.702 and Hosmer-Lemeshow p=0.748, suggesting the model fit the data.

Conclusion: A novel non-home discharge risk score was validated in an external single institutional dataset. This risk score could be used to provide better pre-operative counseling and streamline post-discharge planning. Future studies should prospectively validate the NHD risk score.