Coronary artery bypass grafting in the elderly: changing trends and results
J M Smith1, R Rath, D J Feldman
1Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio.
Insights
The number of patients aged 75 and older undergoing coronary artery bypass grafting (CABG) is rising. Despite increased risks, selected elderly patients benefit from elective cardiac surgery, showing improved survival and quality of life.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Health Services Research
Background:
- The population undergoing coronary artery bypass grafting (CABG) is aging.
- Demographic shifts necessitate evaluating surgical practices for elderly patients.
Purpose of the Study:
- To analyze the outcomes of coronary artery bypass grafting (CABG) in patients aged 75 and older.
- To assess the impact of changing trends on the safety and efficacy of CABG in the elderly.
Main Methods:
- Retrospective analysis of 1498 patients undergoing CABG between January 1985 and December 1989.
- Subgroup analysis of 109 patients aged 75 and older, examining mortality, survival, and costs.
Main Results:
- The proportion of CABG patients aged 75+ increased from 4.0% (1985) to 12.2% (1989).
- Overall mortality was 9.2%, with significantly higher rates in emergent cases (50%) and concomitant valve replacement (18.8%).
- Actuarial survival reached 86% at 33 months; average hospitalization cost was $27,183 with a 21.3-day stay.
Conclusions:
- Elective cardiac surgery in selected elderly patients (75+) can lead to improved long-term survival and quality of life.
- Careful patient selection is crucial for favorable outcomes in this growing demographic.
- Further research into optimizing care for elderly cardiac surgery patients is warranted.
Abstract:
The subgroup of candidates age 75 and older for coronary artery bypass grafting (CABG) is increasing. Changing demographics have also influenced current practice. Between January 1985 and December 1989, 1498 patients underwent CABG; 109 (7.3%) were 75 or older (mean 77.3, range 75-87). This increased from 4.0% in 1985 to 12.2% in 1989. Mortality was 9.2% (elective cases 7.6%, emergent 50%), early mortality (0-10 days) 3.7%, and late deaths (11-90 days) 5.5%. Early deaths were attributable to cardiac failure and late mortality resulted from noncardiac organ failure. Actuarial probability of survival was 86% at 33 months (range 11-68). Mortality was highest in concomitant valve replacement (18.8%), NYHC IV (13.0%), postoperative bleeding (11.8%), and emergent priority (50%). Average cost for hospitalization per patient was $27,183; average length of stay in the hospital was 21.3 days. Changing trends have had a positive impact on improved long-term survival and quality of life, justifying continued elective cardiac surgery in selected patients.
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