Skilled Care Requirements for Elderly Patients After Coronary Artery Bypass Grafting Brahmajee K. Nallamothu, MD, MPH, à wk Mary A. M. Rogers, PhD, MS, wk Sanjay Saint, MD, MPH, à wk Laurence J. McMahon, Jr., MD, MPH, w Brant E. Fries, PhD, z §# Samuel R. Kaufman, MSc, wk and Kenneth M. Langa, MD, PhD à wzk z OBJECTIVES: To examine the extent to which elderly in- dividuals 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 ad- mission to a skilled nursing facility (SNF) or readmission to an acute-care hospital within 100 days after discharge. Pa- tients aged 80 and older had a significantly higher risk of admission to a SNF (adjusted RR 5 3.3, 95% confidence interval (CI) 5 2.8–4.0) than did those aged 65 to 69, as did patients aged 75 to 79 (adjusted RR 5 2.2, 95% CI 5 1.8– 2.6) and those aged 70 to 74 (adjusted RR 5 1.5, 95% CI 5 1.3–1.8). The length of time spent in skilled care fa- cilities significantly increased with age (mean days 5 13.3 for aged 65–69, 16.9 for 70–74, 19.6 for 75–79, and 22.9 for 80 and older; Po.001). CONCLUSION: Older patients are more likely to be ad- mitted to a SNF, be readmitted to an acute-care hospital, and have longer institutional stays after CABG. When bal- ancing 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. J Am Geriatr Soc 53:1133–1137, 2005. Key words: aged; long-term care; skilled nursing facilities; health resources; Medicare; aftercare C oronary artery bypass grafting (CABG) is effective at relieving symptoms and improving functional status in patients aged 80 and older. 1–3 Although initial data sug- gested that CABG in those aged 80 and older was associated with exceptionally high in-hospital mortality rates and complications, more-recent evidence indicates that it is be- coming increasingly safer to perform CABG in the very elderly. 4,5 In-hospital and short-term mortality rates in those aged 80 and older now range from 5% to 14%, and as a result, recent guidelines recommend that age alone should not be a contraindication to CABG. 6 Despite these improvements in in-hospital outcomes after CABG, less is known about skilled care requirements in elderly patients after hospital discharge. This is partic- ularly germane to professionals who counsel patients re- garding postsurgical care and is useful in anticipating the healthcare services needed within the months after dis- charge from the hospital. Two previous studies demon- strated that patients aged 80 and older were at higher risk for discharge to skilled nursing facilities (SNFs) after CABG, but these investigations involved a small number of patients and did not differentiate between those requiring short-term rehabilitation and those requiring extended stays. 7,8 Additional studies have shown that older patients are at higher risk for readmission to an acute-care hospital after CABG but did not report the extent of cross-facility use. 9,10 To better understand the skilled care requirements of older patients after CABG, outcomes were evaluated in the Medicare population of Michigan. Answers to the follow- ing questions were of particular interest. What is the extent of post-CABG use of skilled care facilities with regard to type of facility and number of admissions in the elderly? Address correspondence to Brahmajee K. Nallamothu, MD, MPH, Department of Internal MedicineFCardiology, B1226 Taubman Center, Ann Arbor, MI 48109. E-mail: bnallamo@umich.edu DOI: 10.1111/j.1532-5415.2005.53356.x From the à Health Services Research and Development Center of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan; w Department of Internal Medicine, Medical School, z Institute for Social Research, § Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan; k Patient Safety Enhancement Program, University of Michigan Health System, z SGIM- Hartford Collaborative Center for Research and Education in the Care of Older Adults, University of Michigan Health System, Ann Arbor, Michigan; and # Geriatric Research Education, and Clinical Center, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. JAGS 53:1133–1137, 2005 r 2005 by the American Geriatrics Society 0002-8614/05/$15.00