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An audit of cardiac surgery in patients aged over 70 years
A J Parry1, N Giannopolous, O Ormerod
1Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe 3 Hospital, Headington, UK.
Insights
Cardiac surgery in patients over 70 is safe and effective, especially when performed electively. Early referral for cardiovascular disease treatment improves outcomes and reduces mortality in this age group.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiovascular Surgery
Background:
- The aging population is increasing the demand for cardiovascular disease treatments.
- Historically, cardiac surgery in patients over 70 has been considered a last resort with poor expected outcomes.
Purpose of the Study:
- To evaluate the appropriateness of cardiac surgery for patients over 70.
- To determine if the timing of surgery (elective vs. emergency) impacts patient outcomes.
Main Methods:
- A retrospective analysis of 306 patients aged 70 and above who underwent cardiac surgery over 4.5 years.
- Patients were categorized into elective (210) and emergency (96) groups.
- Surgical and post-operative management methods were consistent with those used for younger patients.
Main Results:
- Overall mortality was 6.9% (1.9% for elective, 16.7% for emergency).
- Morbidity, post-operative ventilation, and hospital stay were similar between elective and emergency groups.
- 87% of survivors improved to NYHA class I or II, with low rates of late cardiac events or re-operation.
Conclusions:
- Elective cardiac surgery in patients over 70 demonstrates low mortality and favorable long-term outcomes.
- Early referral for cardiovascular disease intervention is crucial to prevent emergency surgery and improve patient prognosis.
- Cardiac surgery is a viable and effective treatment option for selected elderly patients.
Abstract:
With an increasingly aged population, the number of patients requiring treatment for cardiovascular diseases will rise. Previous expectations of cardiac surgery in the over-seventies have been poor, with surgery being very much a last resort. We decided to test whether this was appropriate, and to determine whether the priority of surgery affected the outcome. Three hundred and six patients over the age of 70 were operated on in our unit in a 4 1/2-year period, 210 as elective operations and 96 as emergencies. Eighty-nine per cent were in NYHA class III-IV pre-operatively and half had other significant medical problems. Most (46%) underwent coronary artery surgery. The methods used were identical to those used for the younger patients in both operative approach and post-operative management. The overall mortality was 6.9%; 1.9% for elective procedures and 16.7% for emergencies (12.3% when catastrophic pathologies are excluded). However, the morbidity was not significantly different between the two groups and the length of post-operative ventilation and hospital stay were likewise not significantly different. Follow-up of the survivors showed no late deaths, and 87% were in NYHA class I and II. Of the others, 25 have required additional hospital admissions for associated cardiac problems. One required another invasive procedure (a PTCA), but none has required further surgery. The findings of low mortality for elective cardiac surgery in this age group are in agreement with other reports. If early referral prevents emergency surgery, it should be avidly pursued, in view of the improved outcome for elective surgery.(ABSTRACT TRUNCATED AT 250 WORDS)