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Published on: March 27, 2018
Coronary Artery Bypass Grafting Among Older Adults: Patterns, Outcomes, and Trends
Olubode A Olufajo1, Amanda Wilson2, Ahmad Zeineddin1
1Department of Surgery, Howard University College of Medicine, Washington, District of Columbia.
Insights
Coronary artery bypass grafting (CABG) volumes decreased in adults 85+ years, with rising comorbidities. However, surgical outcomes improved, suggesting better patient care and optimization strategies for this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Health Services Research
Background:
- The US population is aging rapidly, increasing the need for data on surgical outcomes in older adults.
- Recent data on coronary artery bypass grafting (CABG) use and outcomes in adults aged 85 years and older is limited.
Purpose of the Study:
- To evaluate the characteristics and outcomes of very elderly patients undergoing CABG.
- To identify temporal trends in CABG utilization and outcomes for adults aged 85 years and older.
Main Methods:
- Analysis of the National Inpatient Sample (NIS) database from 2005 to 2014.
- Inclusion of patients aged 85 years and older who underwent CABG.
- Evaluation of demographic, clinical, and hospital characteristics, along with outcomes such as mortality, length of stay, discharge disposition, and complications. Trend analyses were performed on 2-year increments.
Main Results:
- A total of 60,124 patients aged 85+ years were included. Annual CABG surgical volume decreased over the study period.
- Hospital mortality decreased from 8.5% to 5.5%, and mean hospital length of stay decreased from 13.9 to 12.0 days.
- Patients undergoing CABG in later years had a higher burden of comorbidities, including diabetes, chronic kidney disease, peripheral artery disease, and hypertension, despite improved outcomes.
Conclusions:
- Coronary artery bypass grafting (CABG) volumes are declining in the very elderly population (85+ years).
- Despite an increasing prevalence of comorbidities in this group, outcomes such as mortality and length of stay have improved.
- These findings suggest advancements in preoperative optimization and perioperative care for older adults undergoing CABG.
Introduction:
Although the numbers of older adults in the US are rapidly increasing, there is sparse recent data on the use and outcomes of coronary artery bypass grafting (CABG) among this population. We aimed to evaluate the characteristics and outcomes of older adults undergoing CABG and to measure temporal trends.
Materials And Methods:
Using data from the National Inpatient Sample (2005-2014), patients aged 85 y and older who underwent CABG were selected. Demographic, clinical, and hospital characteristics were extracted. Outcomes measured were hospital mortality, hospital length of stay, discharge home, and operative complications. Patients were grouped by 2-year increments. Differences in clinical characteristics and outcomes over time were evaluated using trend analyses.
Results:
There were 60,124 patients included in the cohort. The mean age was 86.8 y with majority being men (61%), white (88%), and treated in teaching hospitals (61%). Over the study period, the annual surgical volume decreased from 6689 in 2005/06 to 5150 in 2013/14. Mortality decreased from 8.5% to 5.5% (P-trend <0.001) and mean hospital length of stay decreased from 13.9 d to 12.0 d (P-trend <0.001), whereas the rate of discharge home remained stable (14.1% versus 11.6%, P-trend = 0.056). Compared with patients in 2005/06, those in 2013/14 had higher comorbidities [diabetes: 27.6% versus 17.3%; chronic kidney disease: 29.8% versus 9.2%; peripheral artery disease: 7.5% versus 6.0%; and hypertension: 83.7% versus 64.5% (all P-trend <0.001)].
Conclusions:
CABG volumes are decreasing among older adults, and comorbidity burden is increasing, but outcomes are improving. These data may indicate improved preoperative optimization and better perioperative care processes.
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