Page 14 - ANZCP Gazette May 2023 TEASER

We then linked the routinely collected data with these few manually-sourced dates and performed the DAH30 calculation using a simple Microsoft Access script, as this was the database software used by both ANZCPR & ANZSCTS databases.
Results:
Figure 3 shows the DAH30 results for our 1332 cardiac patients between September 2019 and May 2022, all comers. Many patients enjoy around 24 days at home out of the 30. The median DAH30 was 21 days (25th centile: 14 days, 75th centile: 24 days)
As one would expect, no one is home a day or two after open heart surgery. Some patients are spending much less time at home, like 5–6 days, while some spend no time at home (DAH30 of zero).
Interestingly, the 2019 Bell study (2) found patients with 8 days or less at home after surgery were at a seven times higher risk of death at 12 months.
The DAH30 zero column is quite interesting (Figure 4). It’s more pronounced in this population than for other non-cardiac surgical populations. The zero column of 154 patients comprises:
• 15% mortality; whether they passed away at home or in hospital or a secondary health facility.
•38% were non-home discharges who were still inpatients at 30 days e.g. at a rehab centre or referring hospital.
• 47% were still inpatients at Westmead Hospital 30 days after their surgery.
This dataset is currently being analysed with a bespoke statistical model designed to accommodate this DAH30 distribution featuring the large spike at zero. I look forward to sharing these more informative results
when finalised. In the meantime, using Kruskal-Wallis equality-of-populations rank sum test, chi-squared with ties, we were able to conduct a simple review of what things had observable differences in DAH30 for our cardiac surgical patients. These tables will help us become familiar with DAH30 and this will be useful to guide our interpretation of future work using DAH30. These results are among some of those presented at 3SCTS last November.
As expected, age has an observed difference in DAH30 (Table 1). Younger people have a median 22 days at
home and much older people have significantly less. Interestingly, there is a significant difference in DAH30 of 21 days for males compared with 20 days for females. This, I’m reliably told, indicates the sensitivity of DAH30 as a measurement. It is surprising that BMI doesn’t
have a significant difference in DAH30, neither does socioeconomic status – unlike what a Canadian study showed (3), nor does indigenous status in this study.
It's also not surprising we demonstrated many cardiac pre-operative risk factors have significant differences in days at home (Table 2).
Table 1: Demographics:
Variable N
Patient age (yrs)
<50 231 50-60 267 60-70 403 70-80 367 >80 64
Sex
Male 1000
Raw Median Iqr p DAH30 DAH30
Female
BMI
Underweight Healthy Overweight Obesity I Obesity II Obesity III
332
15 321 472 304 144 76
22 7 227 219 19 13 15.5 21
21 9 20 11
20 18 21 10 21 8 21 10 21 9 19 12.5
20 10
21 10 22 9 21 9
21 10
21 10 21 5
<0.01
<0.01 0.10
0.07
0.93
SEIFA index of socio-economic disadvantage (IRDS)
1 Most disadvantaged 2
3
4
5 Least disadvantaged
Indigenous Australian
Non indigenous Indigenous
366
151 373 228
210
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11 MAY 2023 | www.anzcp.org