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Postoperative Outcome of High-Risk Octogenarians Undergoing Cardiac Surgery: A Multicenter Observational
Michal Porizka1, Jan Kunstyr1, Tomas Vanek2
1General University Hospital, Department of Anaesthesiology, Resuscitation and Intensive Medicine, The First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Insights
Cardiac surgery outcomes for octogenarians vary by risk. High-risk patients face significantly higher mortality, lower survival rates, and reduced quality of life after cardiac procedures.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiothoracic Surgery
Background:
- Cardiac surgery in octogenarians with poor functional status is increasing.
- Limited outcome data exist for this high-risk demographic.
- Risk stratification is crucial for managing elderly patients undergoing cardiac procedures.
Purpose of the Study:
- To compare postoperative outcomes, survival, and quality of life in low-, medium-, and high-risk octogenarians undergoing cardiac surgery.
- To evaluate the impact of preoperative risk on cardiac surgery results in the elderly.
- To provide data for better patient selection and management in octogenarian cardiac surgery.
Main Methods:
- Retrospective analysis of 285 Czech octogenarians undergoing cardiac surgery from January 2011 to December 2012.
- Data collected from five national cardiac surgical centers.
- Telephone interviews used for patient follow-up.
Main Results:
- High-risk octogenarians had significantly higher 30-day mortality (20%) compared to medium (6.4%) and low-risk (5.2%) groups.
- Two-year survival was lower in the high-risk group (60%) versus medium (84.0%) and low-risk (85.4%) groups.
- High-risk patients experienced lower quality of life (Karnofsky score 44.4) and less improvement in New York Heart Association (NYHA) functional class.
Conclusions:
- Octogenarians classified as high-risk exhibit substantial perioperative mortality and diminished long-term survival following cardiac surgery.
- Postoperative quality of life is notably poor in high-risk elderly patients undergoing these procedures.
- Risk stratification is essential for predicting outcomes in octogenarians undergoing cardiac surgery.
Purpose:
Cardiac surgery in octogenarians with severely deteriorated functional status is increasingly common, but outcome data are still limited. The aim of this study was to compare postoperative outcome, survival, and quality of life of low-, medium-, and high-risk octogenarians undergoing cardiac surgery.
Methods:
In all, 285 Czech octogenarians who underwent any cardiac surgical procedure between January 2011 and December 2012 were included in the study. Five out of all twelve national adult cardiac surgical centers participated in the study, representing almost half of all octogenarians operated in our country in that period. Patients' perioperative data were analyzed retrospectively. Follow-up was performed by interviewing patients by telephone.
Results:
There was higher 30-day mortality (20% vs. 6.4% vs. 5.2%, respectively, p <0.001), lower 2-year survival (60% vs. 84.0% vs. 85.4%, respectively, p <0.05), and lower Karnofsky score (44.4 vs. 70.1 vs. 70.6, respectively, p <0.001) in high-risk group compared with medium- and low-risk groups, respectively. Greater improvement in New York Heart Association (NYHA) status was noted in high- and medium-risk groups compared with low-risk group (51% vs. 45% vs. 24%, respectively, p <0.05).
Conclusion:
High perioperative mortality, poor 2-year survival, and low postoperative quality of life have been observed in high-risk octogenarians undergoing cardiac surgery.
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