[Postoperative cardiac morbidity/mortality in high-risk elderly patients undergoing non-cardiac surgery]

To analyze cardiac morbidity and mortality after major noncardiac surgery in high-risk elderly patients.

Retrospective study of patients 65 years old or older in the postoperative intensive care unit between January 1990 and September 1996, after major noncardiac surgery, with histories of known ischemic heart disease (IHD group) or with two or more coronary risk factors (CRF group). We analyzed age, number of risk factors, type of ischemic heart disease, type and nature of surgery and cardiac morbidity or mortality.

Five hundred twenty-nine patients were studied. Mean age was 72.1 +/- 5.1 years. The CRF group contained 366 patients (69.1%); the IHD group contained 163 (30.2%) patients with angina or histories of myocardial infarction. Rates of morbidity in the two groups were 10.1% and 25.8%, respectively (p < 0.001); the cardiac death rates were 2.18% and 5.5%, respectively (p = 0.08). No effect of number of coronary risk factors, type of ischemic heart disease, or type of surgery was found. Emergency surgery was associated with greater morbidity (p < or = 0.0011 and p < 0.001, respectively) and mortality (p < 0.001 in both groups). Age over 75 years was related to increased rates of morbidity (p = 0.003) and mortality (p = 0.031).

In our practice elderly patients with known ischemic heart disease undergoing major noncardiac surgery suffer more postoperative cardiac complications than do those who only have coronary risk factors. Mortality, however, is similar. The only factors associated with increased morbidity and mortality are emergency surgery and age over 75 years.