Cardiac surgery in octogenarians--The Green Lane Hospital Experience 1995-1998.
BACKGROUND
An increasing number of patients aged 80 years and over are being considered and accepted for cardiac surgery.


OBJECTIVE
To review the experience of surgery in this elderly group of patients at our institution.


METHODS
Hospital records of octogenarians undergoing surgery between January 1995 and September 1998 were reviewed and follow-up was obtained by general practitioner (GP) and patient questionnaires.


RESULTS
Thirty-seven patients underwent cardiac surgery. The mean age was 82.8+/-1.4 years (range 80.8 to 86.2 years). Twenty-three (62%) were male. All were independent pre-operatively with severe symptoms and minor co-existing morbidity. All operations were urgent except two (emergency). Twenty patients (54%) had isolated coronary surgery, six (16%) aortic valve replacement alone, and 11 (30%) combined surgery. There were four (11%) early deaths and five (14%) peri-operative neurological events. The mean duration of post-operative intensive care stay was 2.4+/-3.9 days (range 0.05 to 16, median 1.0) and post-operative hospital stay 14.0+/-13.9 days (range 0 to 79, median 11). At the time of follow-up (mean duration 20.0+/-11.2 months) two further patients had died (non-cardiac). Twenty-six of the 31 survivors were living at home (23 independently), one with relatives, and four in residential care. Their cardiac symptoms were well controlled. The GPs of all hospital survivors, and all surviving patients themselves, felt that cardiac surgery had been beneficial.


CONCLUSIONS
Cardiac surgery in the very elderly has been reserved for those with severe disease or symptoms and little co-morbidity. Early mortality is higher than for the general population undergoing cardiac surgery, but post-operative resource use is acceptable and the intermediate-term outcome for survivors is good.
Wong
S P
SP
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
Dixon
S R
SR
Ruygrok
P R
PR
Legget
M E
ME
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009520:New Zealand; D018579:Patient Selection; D011795:Surveys and Questionnaires; D016896:Treatment Outcome