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Published on: March 27, 2018
Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass
Kristinn Thorsteinsson1, Kirsten Fonager2, Charlotte Mérie3
1Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark kristinn.thorsteinsson@rn.dk.
Insights
Coronary artery bypass grafting (CABG) patients are older and sicker, with increased comorbidities. Despite this, 30-day mortality decreased over time, and long-term survival improved, though outcomes for octogenarians remained stable.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Public Health
Background:
- An increasing number of elderly patients, particularly octogenarians, are undergoing coronary artery bypass grafting (CABG).
- Trends in postoperative mortality and preoperative comorbidity in this demographic over time are not fully understood.
- Understanding these trends is crucial for optimizing surgical care for older adults.
Purpose of the Study:
- To examine age-dependent trends in postoperative mortality following CABG.
- To analyze changes in preoperative comorbidity burden over time in CABG patients.
- To identify predictors of short-term and long-term mortality after CABG in relation to age and time.
Main Methods:
- Nationwide retrospective analysis of isolated CABG patients in Denmark (1996-2012).
- Patients categorized by age groups and surgical periods to assess temporal changes.
- Multivariable Cox proportional-hazard models for 30-day mortality; Kaplan-Meier curves for 1- and 5-year survival.
Main Results:
- 38,830 patients included; median age increased, with a rise in octogenarians (4%) and patients >75 years (10% to 20%).
- Comorbidity burden (e.g., heart failure, diabetes) increased across all age groups over time.
- Despite increased age and comorbidity, 30-day mortality decreased overall, but remained high and stable for octogenarians (8%); long-term survival improved except for octogenarians.
Conclusions:
- CABG patients are older and have more comorbidities, with an increase in urgent/emergency surgeries.
- While overall 30-day mortality decreased and long-term survival improved, octogenarians experienced stable, higher mortality rates.
- CABG in octogenarians can be performed with acceptable risks and good long-term outcomes, despite higher mortality compared to younger patients.
Objectives:
An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.
Methods:
All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves.
Results:
A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (≥80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients <60 years, 8% in octogenarians). The long-term mortality rate at 1 and 5 years was 2 and 7% (age <60 years) and 14 and 36% (age >80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25).
Conclusion:
Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
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