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Cardiac operations in patients 90 years of age and older
C Blanche1, J M Matloff, T A Denton
1Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Insights
Open-heart surgery is a viable option for nonagenarians, offering improved quality of life despite higher risks and costs. Careful patient selection is crucial for successful cardiac operations in the elderly.
Area of Science:
- Cardiology
- Geriatric Surgery
- Health Economics
Background:
- The global elderly population is rapidly expanding, necessitating strategies for independent living and efficient healthcare resource allocation.
- Surgical therapy for the aging demographic presents unique challenges and considerations for future healthcare planning.
Purpose of the Study:
- To evaluate the outcomes and implications of open-heart surgery in nonagenarians (patients over 90 years old).
- To inform the debate on providing advanced surgical procedures for an aging population.
Main Methods:
- Retrospective analysis of 30 nonagenarians (mean age 92.3 years) undergoing cardiac operations.
- Patients were in New York Heart Association (NYHA) class III or IV, with urgent or emergent indications.
Main Results:
- 30-day mortality was 10%; 1-year and 2-year survival rates were 81% and 75%, respectively.
- 78% of survivors improved to NYHA class I or II, indicating enhanced quality of life.
- Care costs for this group were 24% higher than for octogenarians.
Conclusions:
- Advanced age (over 90) alone should not preclude open-heart surgery, though increased morbidity, mortality, and costs are expected.
- Selective criteria for risk-benefit assessment are essential for individual nonagenarian patients.
- The impact of an aging population on healthcare costs and delivery requires strategic consideration in national health-care systems.
Background:
Growth of the elderly population worldwide, and specifically in the United States, will continue to accelerate and will have a profound impact on the cost and delivery of health care resources in the future. A medical strategy that allows the elderly to live independently is essential to most cost-effective use of our resources. The question remains as to what will be the future of surgical therapy for this increasing population.
Methods:
We retrospectively studied the cases of 30 consecutive nonagenarians (mean age, 92.3 +/- 1.8 years) who underwent a cardiac operation within a 9-year period. All patients were in New York Heart Association class III or IV and underwent operation urgently or emergently.
Results:
The 30-day mortality rate was 10%, and the actuarial survival rates were 81% +/- 8% and 75% +/- 9% at 1 year and 2 years, respectively. Seventy-eight percent of survivors were in New York Heart Association class I or II within 2 years after operation and had an improved quality of life. The cost of providing care in this age group was 24% higher than in octogenarians.
Conclusions:
Advanced age in and of itself (>90 years) should not be a contraindication to an open-heart operation, although morbidity, mortality, and cost may be higher. However, selective criteria identifying risks and benefits for individual patients should be applied. The aging of our population will have a profound impact on the cost and delivery of health care resources in the future. This issue must be addressed in the current debate on the provision of expensive procedures under a realigned national health-care system.