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Published on: March 27, 2018
Impact of coronary artery bypass grafting in elderly patients
Priscila Aikawa1, Angélica Rossi Sartori Cintra, Cleber Aparecido Leite
1Hospital de Cardiologia Doutor Pedro Bertoni da Associação de Caridade da Santa Casa do Rio Grande, Rio Grande, RS, Brasil. priaikawa@hotmail.com
Insights
Elderly patients over 65 undergoing on-pump coronary artery bypass grafting (CABG) face higher postoperative complication risks but not increased mortality. This highlights the need for careful management in older adults undergoing CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Patient demographics are shifting, with an increasing number of elderly individuals undergoing major cardiac surgery.
- Understanding the specific risks and outcomes for older adults undergoing CABG is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the outcomes of isolated on-pump coronary artery bypass graft surgery (CABG) in patients aged 65 years and older.
- To compare the morbidity and mortality rates between elderly (>= 65 years) and adult (< 65 years) patients undergoing on-pump CABG.
- To identify predictive factors for in-hospital mortality in this patient population.
Main Methods:
- A retrospective analysis of patients undergoing isolated on-pump CABG between December 2010 and July 2012.
- Patients were divided into two groups: elderly (GE, > 65 years, n=103) and adult (GA, < 65 years, n=150).
- Preoperative, intraoperative (e.g., bypass time, clamping time, mechanical ventilation duration), and postoperative variables (morbidity, mortality, hospital stay) were analyzed.
Main Results:
- The elderly group (GE) exhibited a significantly higher morbidity rate (30% vs. 14%, P=0.004) compared to the adult group (GA).
- No significant difference in in-hospital mortality rates was observed between the GE and GA groups (5.8% vs. 2.0%, P=0.165).
- Multivariate analysis indicated that age > 65 was associated with increased morbidity but not an independent predictor of in-hospital mortality; longer ward stay and cardiac/respiratory complications were independent predictors of mortality.
Conclusions:
- Patients over 65 years old undergoing isolated on-pump CABG are at an increased risk of postoperative complications compared to younger patients.
- Despite higher morbidity, advanced age itself is not an independent predictor of increased in-hospital mortality after on-pump CABG.
- Factors such as prolonged hospital stay and specific complications (cardiac, respiratory) are critical determinants of mortality in patients undergoing CABG.
Objective:
To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients > 65 years-old.
Methods:
Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly > 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation--MV--and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization.
Results:
In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age > 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors.
Conclusion:
This study suggests that patients > 65-year old were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.
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