Related Experiment Videos

Cost and cost-effectiveness of cardiac surgery in elderly patients

Sandro Gelsomino1, Roberto Lorusso, Ugolino Livi

  • 1Cardiac Surgery Unit, Careggi Hospital, Florence, Italy. sandro.gelsomino@libero.it

The Journal of Thoracic and Cardiovascular Surgery
|April 16, 2011
PubMed

Insights

Cardiac surgery in octogenarians improved quality of life but had higher costs. The cost-effectiveness ratio for elderly surgical patients was $94,426, indicating ongoing debate in healthcare economics.

Area of Science:

  • Cardiovascular Surgery
  • Health Economics
  • Geriatric Medicine

Background:

  • The cost-effectiveness of cardiac surgery for elderly patients, particularly octogenarians, is not well-established.
  • Evaluating outcomes, quality of life (QoL), and economic impact is crucial for informed clinical decisions.

Purpose of the Study:

  • To assess the outcome, quality of life (QoL), cost, and cost-effectiveness of octogenarians undergoing cardiac surgery.
  • To compare these metrics with younger cardiac surgery patients and control groups.

Main Methods:

  • Prospective study of 1640 octogenarians undergoing cardiac surgery (1998-2009), compared to 70-79 year olds.
  • QoL assessed via questionnaires; costs obtained from hospital financial data.
  • Cost-effectiveness analyzed using cost per QoL-adjusted life year (QALY) and cost-effectiveness ratio.

Main Results:

  • Elderly surgical patients showed significant QoL improvements in physical role, pain, general health, and social/role emotional functioning.
  • Total direct costs were $5293 higher in octogenarians compared to younger patients.
  • Cost-effectiveness was $1391/QALY for elderly surgical patients, with a cost-effectiveness ratio of $94,426.

Conclusions:

  • Cardiac surgery in the elderly remains controversial regarding cost-effectiveness.
  • Econometric analysis is vital for evaluating new cardiovascular therapies in this population.
  • Further multicenter studies are needed to validate these findings.
Abstract

Related Concept Videos

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...