Coronary artery bypass grafting in octogenarians: an Australian experience
Liam Bibo1, Joshua Goldblatt1,2, Ryan Cohen3,4
1Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Insights
Coronary artery bypass grafting (CABG) in octogenarians shows increased post-operative complications and longer hospital stays but comparable survival rates to younger patients. CABG remains a safe and viable option for elderly individuals.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Outcomes Research
Background:
- Octogenarian patients represent a growing demographic undergoing cardiac procedures.
- Assessing the safety and efficacy of Coronary Artery Bypass Grafting (CABG) in this age group is crucial.
Purpose of the Study:
- To evaluate early and mid-term morbidity and mortality in octogenarian patients after CABG.
- To compare outcomes of CABG in octogenarians versus younger patient cohorts.
Main Methods:
- Retrospective analysis of 901 cardiac surgery patients from February 2015 to September 2019.
- Inclusion criteria: all patients undergoing CABG; exclusion criteria: concomitant valve or aortic procedures.
- Comparison of outcomes between 37 octogenarian patients and younger patients.
Main Results:
- Octogenarians experienced higher rates of post-operative transfusion, acute kidney injury, and atrial fibrillation.
- A higher rate of return to the operating theatre was observed in octogenarians (13.5% vs 4.7%).
- Despite increased morbidity, octogenarians showed no significant difference in hospital readmission, in-hospital mortality, or 1-year mortality compared to younger patients.
Conclusions:
- Coronary Artery Bypass Grafting in octogenarians is associated with increased post-operative morbidity and longer length of stay.
- Survival rates at 24 and 36 months were comparable between octogenarian and younger patient groups.
- CABG is a safe and effective management strategy for octogenarian patients.
Background:
The aims of this study were to describe early and mid-term morbidity and mortality in octogenarian patients undergoing CABG, to determine if outcomes are comparable to younger patients undergoing the same procedure.
Methods:
We conducted a retrospective analysis of the first 901 patients who underwent cardiac surgery at a large newly established tertiary hospital in Western Australia from February 2015 to September 2019. Inclusion criteria involved all patients undergoing coronary artery bypass grafting. Exclusion criteria included patients who underwent concomitant valve or aortic procedure.
Results:
From a cohort of 901 patients, 37 octogenarian patients underwent CABG. Octogenarian patients had a higher rate of post-operative transfusion 35.1% versus 21.4% (P = 0.048), a higher rate of post-op acute kidney injury 40.5% versus 17.2% (P < 0.0001), a higher rate of post-operative atrial arrythmia requiring treatment 40.5% versus 22.5% (P = 0.011) and higher rate of return to theatre (13.5% versus 4.7%, P = 0.018), with bleeding/tamponade being the most likely reason (10.8% versus 2.7%). Octogenarian patients had a longer post-operative length of stay (LOS) with a median LOS of 10 versus 7 days (P < 0.0001). There was no increase in hospital readmission rate, in-hospital mortality or 1 year mortality in octogenarian patients. 24-month and 36-month survivals were 95.2% and 89.6% in octogenarians and 95.3% and 91.5% in the younger group.
Conclusions:
Despite an increase in post-operative morbidity and LOS, there was no difference in hospital readmission, in-hospital mortality or 1 year mortality in octogenarian patients who underwent CABG. CABG is safe and remains an important management option for these patients.
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