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Cardiac surgery in the octogenarian: evaluation of risk, cost, and outcome
1The Department of Cardiac Surgery, The Research Institute, California Pacific Medical Center, San Francisco, USA. leyj@sutterhealth.org
Background:
Nationwide, cardiac surgery is being performed more frequently in patients aged 80 years and older.
Methods:
One hundred four octogenarians undergoing a variety of heart-lung procedures were prospectively studied between 1995 and 1998 for comparison with similar patients aged 65 to 75 years (n = 351).
Results:
Octogenarians were more likely to be of female gender, and be nondiabetic than the younger group. The 30-day mortality rate for patients aged 65 to 75 years was 3.4% (12 of 351 patients), versus 13.5% (14 of 104) for patients aged 80+ (p = 0.0004), which ranged from 2% (1 of 50) in nonemergent coronary artery bypass grafting to 75% (3 of 4) in double valve procedures. Complications occurring more frequently in octogenarians were severe low output state, reintubation, and atrial fibrillation. Elders experienced a longer intensive care (69.2 versus 43.3 hours, p = 0.002) and postoperative stay (10.09 versus 7.45 days, p = 0.001), and were discharged to a skilled nursing facility more often than younger patients (47% versus 21.1%, p = 0.0001). Total direct costs were $4,818 higher in the octogenarian group (p = 0.0007).
Conclusions:
Although emergency operations and complex procedures carried high risks for the octogenarian, the majority of these patients can be offered operation with short-term morbidity, mortality, and resource use that only modestly exceeds that of younger patients.