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Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and
Bharathi H Scott1, Frank C Seifert, Roger Grimson
1Department of Anesthesiology, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, NY 11794-8480, USA. Bharathi.Scott@stonybrook.edu
Insights
Octogenarians undergoing coronary artery bypass grafting (CABG) experienced higher resource use, longer intensive care unit (ICU) stays, and increased complications. Age 80 and older independently predicts greater resource utilization and mortality after CABG.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Health Services Research
Background:
- Octogenarians represent a growing patient population undergoing major cardiac procedures.
- Understanding resource utilization and outcomes in this age group is crucial for healthcare planning.
Purpose of the Study:
- To compare resource utilization, morbidity, and mortality in octogenarians versus younger patients undergoing coronary artery bypass grafting (CABG).
- To identify predictors of adverse outcomes in elderly patients undergoing CABG.
Main Methods:
- Retrospective analysis of 1746 patients (155 octogenarians) undergoing CABG at a tertiary care center.
- Data collected included time to extubation, blood transfusions, intensive care unit (ICU) and hospital length of stay (LOS), morbidity, and mortality.
- Multivariate regression models were used to assess the impact of age and comorbidities.
Main Results:
- Octogenarians had higher rates of preoperative comorbidities and required more packed red blood cell transfusions (88.4% vs 58.6%).
- Octogenarians experienced longer endotracheal extubation times (9.3 vs 6.3 hours), ICU LOS (1.9 vs 1.4 days), and postoperative LOS (8.7 vs 5.8 days).
- Higher incidence of postoperative renal failure, neurologic complications, and 30-day mortality (9.0% vs 1.2%) was observed in octogenarians.
Conclusions:
- Octogenarians undergoing CABG demonstrate significantly increased resource utilization, morbidity, and mortality compared to younger patients.
- Age 80 years or older is an independent predictor of adverse outcomes, including increased resource use and postoperative complications.
Objective:
The purpose of the present study was to examine resource utilization in octogenarians undergoing coronary artery bypass grafting (CABG) and compare it with usage in their younger cohorts at a tertiary care heart center. The resources examined were time to extubation, packed red blood cell transfusions, intensive care unit (ICU) length of stay (LOS), and preoperative and postoperative LOS. The study also examined differences in postoperative morbidity and mortality.
Design:
Retrospective hospital follow-up study of consecutive patients undergoing CABG using a prospectively designed database.
Setting:
University teaching tertiary care referral center for cardiac surgery.
Participants:
Seventeen hundred forty-six male and female patients undergoing CABG surgery, including 155 octogenarians and 1591 patients younger than 80 years.
Interventions:
None.
Measurements And Main Results:
Demographic, mortality, morbidity, and resource utilization data were collected from the records of patients undergoing CABG at the authors' institution over 3 years. There were 1746 patients: 155 octogenarians and 1591 nonoctogenarians. Octogenarians had a significantly higher incidence of preoperative stroke, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and left main disease. They weighed significantly less, and had lower preoperative and postoperative hematocrit. There was a significantly higher percentage of women in the octogenarian group. Mean time from the end of surgery to endotracheal extubation was 9.3 hours for octogenarians and 6.3 hours for their younger cohorts (p < 0.001). Blood transfusion was required in 88.4% of octogenarians compared with 58.6% of nonoctogenarians (p < 0.001). Mean ICU LOS was 1.9 days for octogenarians and 1.4 days for nonoctogenarians (p < 0.001). Mean postoperative LOS was 8.7 days for octogenarians and 5.8 days for nonoctogenarians (p < 0.001). Clinical and demographic variables were correlated with age 80 years or older. Multivariate linear and logistic regression models were constructed to show the combined effects of age and comorbid conditions on outcomes. Octogenarians had a significantly higher incidence of postoperative renal failure and neurologic complications. The 30-day mortality rate was 9.0% for the octogenarian group v 1.2% for the younger group (p < 0.001). Age 80 years or older was significantly associated with outcome, and was an independent predictor of increased resource utilization and postoperative mortality and morbidity.
Conclusions:
The results demonstrated that octogenarians undergoing CABG required increased resource utilization and had significantly higher morbidity, with increased incidence of postoperative renal failure, neurologic complications, and 30- day mortality. Age 80 years or older was an independent predictor of increased resource utilization, postoperative morbidity, and mortality.
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