Non-Home Discharge is Not Associated with Mortality Following Bilateral Lung Transplant

Abstract

Non-home discharge (NHD) has been associated with adverse outcomes and mortality in other surgical disease processes. The aim of this study is to assess the association of NHD and mortality after bilateral lung transplant. We hypothesized NHD was associated with increased mortality after bilateral lung transplantation. Our institutional Society of Thoracic Surgeons Database was queried for bilateral lung transplants performed between 2012-2018. The primary endpoint was mortality. Secondary endpoints included a composite of stroke/TIA, prolonged ventilation, pneumonia and renal failure. The chi square and Kruskal-Wallis tests were used to compare the distributions of variables by discharge location. Kaplan-Meier plot and log rank test were used to compare survival between groups. A multivariable Cox model assessed the effect of NHD and covariates on survival. A total of 376 patients were included in the analysis; of which 125 (34%) required NHD. On bivariate analysis, the following were associated with NHD: age (median 56 vs 61 years, p=.001), cardiopulmonary bypass use (39% vs 57%, p=.001), operative time (median 5.8 hours vs 6 hours, p=0.049), time in initial intensive care unit stay (117 hours vs 235 hours, p<.001), and the composite of post-surgical complications (89% vs 97%, p=.020). On multivariate analysis, none of the covariates were associated with long-term survival. On Kaplan-Meier and log rank analysis, there was no association between NHD and survival (p=.504). The cumulative hazard analysis showed a trend toward higher rates of early, but not late mortality for the NHD cohort. NHD occurred in 34% of bilateral lung transplants. There was no association between NHD and mortality.