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Discharge to home rates are significantly lower for octogenarians undergoing coronary artery bypass graft surgery
Hasmet Bardakci1, Faisal H Cheema, Veli K Topkara
1Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University-New York Presbyterian Hospital, New York, New York 10032, USA.
Insights
Outcomes for octogenarians undergoing coronary artery bypass graft surgery (CABG) show higher mortality and complications, with significantly lower discharge to home rates. Full functional recovery is crucial for assessing CABG success in this elderly population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Health Services Research
Background:
- Increasing incidence of coronary artery bypass graft surgery (CABG) in elderly patients.
- Need to evaluate clinical outcomes specifically for octogenarians (80 years and above).
Purpose of the Study:
- To evaluate the clinical outcomes of octogenarians undergoing CABG.
- To identify predictors of in-hospital mortality in this age group.
Main Methods:
- Analysis of the New York State Department of Health's Cardiac Reporting System (1998-2002).
- Inclusion of 88,154 patients undergoing isolated CABG.
- Stratification into four age groups: <50, 50-64, 65-79, and 80+ years.
Main Results:
- Octogenarians (9.3% of cohort) had worse coronary artery disease and higher preoperative risk factors.
- Significantly higher length of hospital stay, in-hospital mortality, and postoperative complications in octogenarians.
- Key predictors of mortality included renal failure, recent myocardial infarction, COPD, heart failure, emergent operation, and low ejection fraction.
Conclusions:
- Early outcomes of CABG in octogenarians are acceptable but not sufficient to define overall success.
- Lower discharge to home rates highlight a need for further consideration beyond immediate survival.
- Focus on comprehensive functional recovery is essential for successful CABG in octogenarians.
Background:
The incidence of coronary artery bypass graft surgery (CABG) performed in elderly patients has been increasing over recent years. We sought to evaluate clinical outcomes of octogenarians undergoing CABG using an audited state-wide mandatory database.
Methods:
New York State Department of Health's Cardiac Reporting System was analyzed from 1998 to 2002. In all, 88,154 patients undergoing isolated CABG were identified. Patients were divided into four age groups: less than 50 years (group 1, n = 6,527), 50 to 64 years (group 2, n = 30,088), 65 to 79 years (group 3, n = 43,369), and 80 years and above (group 4, n = 8,170).
Results:
Of all patients, 9.3% were octogenarians. In addition to marginally worse coronary artery disease, octogenarians generally manifested a higher incidence of preoperative risk factors such as cerebrovascular disease, peripheral vascular disease, and congestive heart failure compared with younger patients at baseline. Both length of hospital stay and in-hospital mortality rate were significantly higher among octogenarians. The incidence of postoperative complications was higher among octogenarians. Multivariate analysis demonstrated renal failure requiring dialysis (odds ratio [OR] = 4.4), myocardial infarction within 6 hours before surgery (OR = 3.6), chronic obstructive pulmonary disease (OR = 1.7), congestive heart failure at admission (OR = 1.7), emergent operation (OR = 1.6), Canadian Cardiovascular Society functional class IV (OR = 1.5), hypertension (OR = 1.4), and low ejection fraction (OR = 0.98) to be significant independent predictors of in-hospital mortality of octogenarians. Discharge to home rates were significantly lower for octogenarians.
Conclusions:
Although early outcomes in octogenarians are acceptable, these factors alone are not sufficient to reflect overall success of CABG in these patients, given the strikingly lower discharge to home rates. Attention to full functional recovery in octogenarians is essential.
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