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Cardiac surgery for octogenarians: is it an informed decision?
Mohamed Y Rady1, Daniel J Johnson
1Department of Critical Care Medicine, Mayo Clinic Hospital, Mayo Clinic Scottsdale, Phoenix, Ariz, USA.
American Heart Journal
|February 5, 2004
Summary
Outcomes after cardiac surgery for octogenarians are poor, with significantly higher rates of death or nursing home discharge compared to younger patients. Further research is needed to guide treatment decisions for this age group.
Area of Science:
- Cardiology
- Geriatric Medicine
- Surgical Outcomes
Background:
- Cardiac surgery is often performed for octogenarians without robust clinical trial data.
- The benefits of cardiac surgery in octogenarians remain uncertain.
- This study investigates outcomes in octogenarians undergoing cardiac surgery.
Purpose of the Study:
- To compare the rates of death or discharge to a nursing care facility after cardiac surgery in octogenarians versus younger patients.
- To identify predictors of adverse outcomes in octogenarians undergoing cardiac surgery.
Main Methods:
- An inception cohort study was conducted in a tertiary care teaching hospital.
- Data were collected on 783 patients undergoing coronary grafting, valve surgery, or both over 36 months.
- Preoperative disease, operation characteristics, postoperative complications, and discharge outcomes were analyzed.
Main Results:
- Octogenarians (96/783) had higher rates of comorbidities and postoperative complications.
- Death or discharge to a nursing care facility was significantly more frequent in octogenarians (53% vs. 14%, P <.002).
- Independent predictors for adverse outcomes included age ≥80 years, female sex, congestive heart failure, and surgical re-exploration.
Conclusions:
- Cardiac surgery in octogenarians is associated with a high rate of death or nursing home placement.
- Current outcome measures do not adequately capture the differences between octogenarians and younger patients.
- Informed discussions on treatment options, quality of life, and potential for nursing home discharge are crucial for octogenarians considering cardiac surgery.