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Rapid recovery of octogenarians following coronary artery bypass grafting
R A Ott1, D E Gutfinger, M Miller
1Division of Cardiothoracic Surgery, University of California Irvine Medical Center, Orange, USA.
Insights
Rapid recovery protocols for coronary artery bypass grafting (CABG) are effective for octogenarians, with 71% discharged in under 10 days. However, comorbidities like obesity and peripheral vascular disease may prolong recovery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Critical Care Medicine
Background:
- Rapid recovery protocols (RRPs) significantly reduce hospital length of stay (LOS) in younger coronary artery bypass grafting (CABG) patients.
- The efficacy of RRPs in octogenarian populations remains understudied.
Purpose of the Study:
- To evaluate the effectiveness of a rapid recovery protocol in octogenarian patients undergoing isolated CABG.
- To identify factors influencing postoperative recovery and LOS in this demographic.
Main Methods:
- A cohort of 37 octogenarians undergoing isolated CABG with cardiopulmonary bypass (CPB) were treated using a specific RRP.
- The protocol included preoperative intra-aortic balloon pump placement, minimized CPB time, early extubation, perioperative steroids, thyroid hormone administration, and aggressive diuresis.
Main Results:
- The 30-day operative mortality was 5.4%.
- 71% of patients (Group I) achieved discharge in <10 days (average LOS 6.3 days), while 29% (Group II) had LOS ≥10 days (average 20.3 days).
- Group II patients exhibited higher rates of obesity, symptomatic peripheral vascular disease, and preoperative ambulatory difficulties.
Conclusions:
- Octogenarians can achieve favorable outcomes with RRPs following CABG, with a majority discharged within 10 days.
- Comorbidities such as obesity, peripheral vascular disease, and mobility issues are associated with slower rehabilitation and longer LOS in this patient group.
Background:
Rapid recovery protocols for coronary artery bypass grafting (CABG) have resulted in major decreases in postoperative hospital length of stay (LOS) when applied to younger patients undergoing elective procedures. However, the effectiveness of rapid recovery protocols when applied to octogenarians has not been thoroughly studied.
Methods:
Thirty-seven consecutive octogenarians underwent isolated CABG utilizing cardiopulmonary bypass (CPB). A protocol emphasizing preoperative placement of the intra-aortic balloon pump, reduced CPB time, early extubation, perioperative steroids, thyroid hormone, and aggressive postoperative diuresis was used.
Results:
The 30-day operative mortality for the entire series was 5.4%. Twenty-five patients (71%, group I) were discharged in < 10 days postoperatively (average LOS of 6.3 +/- 1.6 days), while ten patients (29%, group II) were discharged at 10 or more days postoperatively (average LOS of 20.3 +/- 8.0, p < 0.001). Patients in group II were found to have a higher incidence of obesity (50% vs 4%, p < 0.01), symptomatic peripheral vascular disease (60% vs 8%, p < 0.01), and preoperative ambulatory difficulties (50% vs 0%, p < 0.01). The incidence of complications was 31% for the entire series, with no differences between the groups.
Conclusion:
Octogenarians performed well under a rapid recovery protocol, with 71% being discharged in < 10 days postoperatively, while patients with obesity, symptomatic peripheral vascular disease, and ambulatory difficulties rehabilitated more slowly.