Cardiac surgery in the octogenarian: evaluation of risk, cost, and outcome.
BACKGROUND
Nationwide, cardiac surgery is being performed more frequently in patients aged 80 years and older.


METHODS
One hundred four octogenarians undergoing a variety of heart-lung procedures were prospectively studied between 1995 and 1998 for comparison with similar patients aged 65 to 75 years (n = 351).


RESULTS
Octogenarians were more likely to be of female gender, and be nondiabetic than the younger group. The 30-day mortality rate for patients aged 65 to 75 years was 3.4% (12 of 351 patients), versus 13.5% (14 of 104) for patients aged 80+ (p = 0.0004), which ranged from 2% (1 of 50) in nonemergent coronary artery bypass grafting to 75% (3 of 4) in double valve procedures. Complications occurring more frequently in octogenarians were severe low output state, reintubation, and atrial fibrillation. Elders experienced a longer intensive care (69.2 versus 43.3 hours, p = 0.002) and postoperative stay (10.09 versus 7.45 days, p = 0.001), and were discharged to a skilled nursing facility more often than younger patients (47% versus 21.1%, p = 0.0001). Total direct costs were $4,818 higher in the octogenarian group (p = 0.0007).


CONCLUSIONS
Although emergency operations and complex procedures carried high risks for the octogenarian, the majority of these patients can be offered operation with short-term morbidity, mortality, and resource use that only modestly exceeds that of younger patients.
Avery
G J
GJ
The Department of Cardiac Surgery, The Research Institute, California Pacific Medical Center, San Francisco, USA. leyj@sutterhealth.org
Ley
S J
SJ
Hill
J D
JD
Hershon
J J
JJ
Dick
S E
SE
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D004630:Emergencies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate