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Changing profile of elderly patients undergoing coronary bypass surgery
Insights
Elderly patients undergoing coronary artery bypass grafting (CABG) are increasingly high-risk. This trend indicates a growing need for specialized care strategies for older adults undergoing this cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Health Services Research
Background:
- The number of elderly patients undergoing coronary artery bypass grafting (CABG) has increased over time.
- Assessing the evolving risk profile of this demographic is crucial for surgical outcomes.
Purpose of the Study:
- To determine if elderly patients undergoing CABG are at a higher risk compared to previous years.
- To analyze trends in patient characteristics and operative risk in older adults undergoing CABG.
Main Methods:
- A retrospective analysis of 1536 patients aged 70-77 years who underwent CABG between 1987 and 2001.
- Patients were divided into five groups based on the year of surgery (1987-2001).
- Operative risk was evaluated using the Euroscore, with adjustments for emergency procedures.
Main Results:
- The proportion of elderly patients in the study population increased significantly (12.5% to 24.1%).
- Mean patient age and prevalence of comorbidities (neurological, renal, lung disease) increased.
- While overall hospital mortality decreased, the calculated operative risk, particularly when considering elective cases, showed a significant increase.
Conclusions:
- There has been a notable increase in both the number and the proportion of high-risk elderly patients undergoing CABG.
- This suggests a shift towards treating more complex cases in older populations, necessitating careful risk stratification and management.
Objective:
Are elderly patients now undergoing CABG at higher risk than several years ago?
Methods:
1536 patients, aged between 70 and 77 years, who underwent CABG between January 1987 and December 2001, were analysed. Group A 1987-1989 (n=177); group B 1990-1992 (n=243); group C 1993-1995 (n=362); group D 1996-1998 (n=418); and group E 1999-2001 (n=336). The Euroscore evaluated operative risk.
Results:
There was an increase in the percentage of the study population from 12.5 to 24.1% (p=0.000). Mean age increased from 72.1±1.8 to 73.2±1.9 years (p=0.047). The percentage of patients with neurological (p=0.002), renal (p=0.013) and lung disease (p=0.04), a previous PTCA (p=0.000), left main stenosis (p=0.003), impaired ventricular function (p=0.000) and reoperations (p=0.01) increased. Emergency/urgent operations (p=0.001) decreased. Hospital mortality decreased from 7.3 to 5.7% (p=0.34). Only neurological problems increased significantly (p=0.03). The calculated operative risk by Euroscore remained stable (p=0.28). To eliminate the influence of the urgent/emergency situation, the Euroscore was recalculated, supposing that all patients were elective. At that moment a significant increase in the operative risk was seen (p=0.02).
Conclusion:
Over the last few years there has not only been an increase in the number of older patients undergoing CABG, but even in this older population there is an increasing number of high-risk patients.
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