Long-term survival and functional status in the elderly after cardiac surgery

Hospital mortality and morbidity of cardiac surgery have been well described in the elderly, but there is a paucity of data regarding long-term functional status.

To evaluate long-term survival and functional status of patients aged 70 years or older after cardiac surgery.

Retrospective observational study.

University-affiliated tertiary care hospital.

Three hundred and twenty-nine consecutive patients aged 70 or older who had undergone cardiac surgery from January 1990 to December 1993.

Besides postoperative mortality and morbidity, data regarding long-term survival and functional status and preoperative variables affecting these outcomes were analyzed.

Mean age at surgery was 73.9 +/- 2.9 years, and 70.2% of the procedures were performed on an urgent basis. Postoperative mortality was 9.4%. Five-year Kaplan-Meier survival in postoperative survivors was 85.9% and is comparable with the survival of the general sex- and age-matched Quebec population. Preoperative variables affecting long-term survival were atrial fibrillation (RR 3.8; 95% CI 1.4 to 10.0), smoking status on admission (RR 3.6; CI 1.6 to 8.1), peripheral vascular disease (RR 2.9; CI 1.4 to 6.2) and low creatinine clearance (RR 1.4; CI 1.1 to 1.7). Functional status evaluated by the Karnofsky score showed a successful functional outcome in 84.6% of patients at follow-up (mean 2.6 +/- 1.1 years). Preoperative variables unfavourably influencing a successful functional outcome were hypertension (OR 0.34; CI 0.15 to 0.76), cerebrovascular disease (OR 0.35; CI 0.15 to 0.87) and low creatinine clearance (OR 0.73; CI 0.55 to 0.96).

Despite severe cardiovascular and often urgent conditions, sustained functional improvement and good long term survival can be objectively documented in most elderly patients after cardiac surgery.