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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
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Coronary artery bypass operations for elderly patients in California, 2003 to 2008

Zhongmin Li1, Ezra A Amsterdam, Khung Keong Yeo

  • 1University of California, Davis Medical Center, Sacramento, California 95817, USA. zhongmin.li@ucdmc.ucdavis.edu

The Annals of Thoracic Surgery
|February 28, 2012
PubMed

Insights

Off-pump coronary artery bypass grafting (OPCAB) significantly reduced operative mortality in elderly patients aged 75-84. While mortality for those 85+ saw no significant change, OPCAB use increased overall for older adults.

Area of Science:

  • Cardiovascular Surgery
  • Geriatric Medicine
  • Health Services Research

Background:

  • Coronary artery bypass grafting (CABG) is increasingly performed on elderly populations.
  • This study investigates operative mortality rates and the impact of off-pump CABG (OPCAB) in elderly Californians from 2003-2008.

Purpose of the Study:

  • To evaluate operative mortality trends in elderly patients undergoing isolated CABG.
  • To assess the specific effect of OPCAB versus on-pump CABG on mortality in older age groups.

Main Methods:

  • Analysis of 101,710 isolated CABGs in California (2003-2008), categorized by age: <75, 75-84, and 85+.
  • Multivariable logistic regression and trend analyses were used to evaluate operative mortality.
  • The "recycled predictions" method assessed the impact of OPCAB on mortality.

Main Results:

  • Operative mortality showed a significant decline in the 75-84 age group (observed-to-expected ratio decreased from 0.958 to 0.633).
  • No significant mortality improvement was observed in the 85+ age group (ratio declined from 1.027 to 0.965).
  • OPCAB use increased among patients 75+ (25.0% to 29.1%), and was associated with a significantly lower odds ratio for operative mortality (0.752).

Conclusions:

  • While overall predicted mortality remained stable, operative mortality decreased significantly for CABG patients aged 75-84.
  • Improvements in surgical outcomes for the 85+ group were not statistically significant.
  • Increased adoption of OPCAB is linked to reduced operative mortality in elderly patients undergoing CABG.
Abstract

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