Coronary Artery Bypass Graft Outcomes Worse for Patients Discharged to SNFs With Low Quality Ratings

Medicare beneficiaries discharged to lower-rated skilled nursing facilities (SNFs) after coronary artery bypass graft (CABG) surgery experienced worse outcomes, according to study findings published in Seminars in Thoracic and Cardiovascular Surgery.

“Recent data has shown that over 20% of patients are discharged to an SNF after CABG, but the link between SNF quality and CABG outcomes has not been established,” wrote a research team from the University of Michigan in Ann Arbor. “The purpose of this study is to evaluate the impact of SNF quality ratings on postoperative outcomes after CABG.”

The study was a retrospective cohort review of 15,522 Medicare patients discharged to an SNF after CABG surgery in 2016 and 2017. Researchers categorized patients into 3 groups based on their nursing facility’s Centers for Medicare and Medicaid Services 5-star quality rating: below average, average, and above average.

According to the results, patients discharged to SNFs rated below average were more likely to be younger, Black, dually eligible for Medicare and Medicaid, and to have more comorbidities. They also experienced higher risk-adjusted 30-day mortality and readmission rates, and longer SNF stays, than patients at above-average SNFs. Compared with a 1.6% mortality rate, a 19.3% readmission rate, and a 16.5-day stay for patients at SNFs rated above average, patients at below-average SNFs had a 2.1% mortality rate, a 21.6% readmission rate, and a 17.3-day stay.

At 90 days, readmission rates were still higher for patients discharged to below-average SNFs compared with above-average SNFs: 31.7% vs. 30.0%. Outcomes at 1 year, however, were not statistically different.

“Identifying best practices at high-performing SNFs, to potentially implement at low-performing facilities, may improve equitable care for patients,” researchers advised.

Reference:
Stewart JW 2^nd, Hou H, Wang Y, et al. Skilled nursing facility quality rating and surgical outcomes following coronary artery bypass grafting. Semin Thorac Cardiovasc Surg. Published online November 16, 2022. doi:10.1053/j.semtcvs.2022.11.007