Impact of risk factors on in-hospital mortality for octogenarians undergoing cardiac surgery
Lindsay Volk1, Joshua Chao1, Viktor Dombrovskiy1
1Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Insights
Octogenarians face higher cardiac surgery mortality, with factors like renal failure impacting them differently than younger patients. This study analyzed risk factors in older adults undergoing heart procedures.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Health Services Research
Background:
- Octogenarians (patients 80 years and older) experience higher mortality rates following cardiac surgery compared to younger individuals.
- Understanding the differential impact of risk factors on mortality in this elderly population is crucial for improving surgical outcomes.
Purpose of the Study:
- To investigate whether common risk factors for mortality in cardiac surgery patients have the same effect on octogenarians as on younger patients.
- To compare the influence of demographic, comorbidity, and admission type factors on in-hospital mortality across different age groups undergoing cardiac procedures.
Main Methods:
- Analysis of the National Inpatient Sample database (2004-2014) for patients aged 65+ undergoing coronary artery bypass grafting (CABG), valvular heart surgery (VHS), or both.
- Patients were stratified into two groups: 65-79 years and 80 years and older.
- Multivariable logistic regression and chi-squared tests were used to compare in-hospital mortality, demographics, comorbidities, and admission types.
Main Results:
- Octogenarians (21.7% of the cohort) exhibited higher in-hospital mortality across all procedures (CABG, VHS, CABG+VHS) compared to younger patients.
- This increased mortality in octogenarians persisted after controlling for gender, race, comorbidities, and admission type.
- While octogenarians had higher rates of risk factors like female gender, renal failure, heart failure, and nonelective admissions, the effect size of renal and heart failure, and surgery type, was smaller in this group.
Conclusions:
- Octogenarians undergoing cardiac surgery present with higher rates of nonelective admissions, renal/heart failure, and female gender, all strongly linked to in-hospital mortality.
- The study indicates that the influence of certain risk factors, particularly renal and heart failure, on mortality is less pronounced in octogenarians compared to younger patients.
- These findings highlight the need for age-specific risk assessment and management strategies in elderly patients undergoing cardiac surgery.
Background:
Octogenarians undergoing cardiac surgery have higher mortality than their younger counterparts.
Objectives:
To determine if various risk factors have the same effect on mortality in octogenarians as in younger patients.
Methods:
The National Inpatient Sample data set from 2004 to 2014 was queried to select patients aged 65 years and older who underwent either coronary artery bypass grafting (CABG), valvular heart surgery (VHS), or both (CABG + VHS) within 10 days of hospital admission. The patients were divided into two groups 65-79 years and 80 years and greater. Hospital mortality, patient demographics, comorbidities, and type of hospital admission was evaluated and compared using χ2 and multivariable logistic regressions.
Results:
About 397,713 patients were identified including 86,345 (21.7%) aged 80 and above. Octogenarians had higher in-hospital mortality for all procedures: CABG (4.94% vs. 2.39%, p < .001), VHS (5.49% vs. 4.08%, p < .001), and CABG + VHS (7.59% vs. 5.95%, p < .001), and this relationship persisted when gender, race, comorbidities, and type of hospital admission were controlled for: CABG (odds ratio [OR] = 1.71; 95% confidence interval [CI] 1.62-1.81); VHS (OR = 1.18; 95% CI 1.11-1.27); and CABH + VHS (OR = 1.17; 95%CI 1.10-1.26). Female gender, renal, or heart failure, nonelective admission, and CABG + VHS were associated with increased risk of in-hospital mortality. Octogenarians had higher rates of these factors (p < .001). The effect size of renal and heart failure and type of surgery was smaller for octogenarians.
Conclusions:
Octogenarians undergoing cardiac surgery have higher rates of nonelective admissions, renal and heart failure, and female gender, which are most strongly associated with in-hospital mortality. Differing effect sizes suggest that certain risk factors, such as renal and heart failure, contribute more to mortality in younger patients.
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