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Published on: March 27, 2018
Long-term survival of the very elderly undergoing coronary artery bypass grafting
Donald S Likosky1, Lawrence J Dacey, Yvon R Baribeau
1Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire 03756, USA. donald.likosky@dartmouth.edu
Insights
Long-term survival after coronary artery bypass graft (CABG) surgery is surprisingly good for very elderly patients, despite higher risks and comorbidities. This study offers crucial insights into outcomes for older adults undergoing CABG.
Area of Science:
- Cardiology
- Geriatric Medicine
- Surgical Outcomes
Background:
- An increasing number of very elderly individuals are undergoing coronary artery bypass graft (CABG) surgery.
- While short-term outcomes are documented, long-term results for this demographic remain understudied.
Purpose of the Study:
- To evaluate the long-term survival and outcomes of very elderly patients undergoing primary, isolated CABG surgery.
- To compare outcomes across different age groups within the elderly population.
Main Methods:
- A cohort study involving 54,397 patients undergoing primary, isolated CABG surgery between July 1987 and June 2006.
- Patient records were linked to the Social Security Administration's Death Master File for long-term follow-up.
Main Results:
- Over 390,871 person-years of follow-up, 17,352 deaths occurred.
- Patients aged 85+ had a crude in-hospital survival of 87.6% and a median survival of 5.8 years, with a 13.7% annual death rate.
- Older patients (80+) were more likely to be female, have emergency priority, and present with comorbidities and morbid events.
Conclusions:
- Despite higher comorbidities and acute presentation, very elderly CABG patients demonstrate surprisingly good long-term survival.
- The study highlights the need to consider long-term benefits for older adults undergoing CABG.
Background:
Increasing numbers of the very elderly are undergoing coronary artery bypass graft surgery (CABG). Short-term results have been studied, but few data are available concerning long-term outcomes.
Methods:
We conducted a cohort study of 54,397 consecutive patients undergoing primary, isolated CABG surgery between July 1, 1987, and June 30, 2006. Patient records were linked to the Social Security Administration's Death Master File.
Results:
During 390,871 person-years of follow-up, there were 17,352 deaths. There were 51,149 patients younger than 80 years, 2,661 patients aged 80 to 84 years, and 587 patients aged 85 or more years who underwent isolated CABG surgery. Crude in-hospital survival was 97.2% for those less than 80 years, 98.3% for those aged 80 to 84 years, and 87.6% for those aged 85 or more years. Patients aged 80 or more years were more likely to be female (46.9%), more likely to be emergency priority (10.2%), and more likely to have associated comorbidities than younger patients. Patients aged 85 or more years were more likely to have intraoperative and postoperative morbid events. Among patients younger than 80, median survival was 14.4 years with an annual incidence of death of 4.2%. Among patients 80 to 84 years old, median survival time was 7.4 years, with an annual incidence rate of death of 10.3%. Among patients aged 85 or more years, median survival was 5.8 years, and the annual incidence of death was 13.7%.
Conclusions:
Although very elderly CABG patients have more comorbidities and more acute presentation than younger patients and their in-hospital mortality rate is high, their long-term survival is surprisingly good.
