Coronary artery bypass grafting in octogenarians: clinical and economic outcomes at community-based healthcare facilities.
BACKGROUND
Results of recent studies from high-volume academic centers suggest that coronary artery bypass grafting (CABG) is becoming safer to perform in octogenarians. Similar data from community-based facilities do not exist.


OBJECTIVE
To assess the clinical and economic outcomes of nonemergency CABG in 338 octogenarians at 27 community-based facilities across the United States.


METHODS
Retrospective cohort analysis.


METHODS
Multivariate analyses were used to compare (1) in-hospital mortality rates, (2) rates of discharge to extended-care facilities, (3) lengths of stay, and (4) in-hospital costs between octogenarians and younger patients.


RESULTS
Of 338 patients 80 years or older, the in-hospital mortality rate was higher (4.7% vs 2.1%; P = .002), the rate of discharge to extended-care facilities was greater (24.9% vs 4.8%; P < .001), the length of stay was longer (9.6 vs 7.9 days; P < .001), and in-hospital costs were higher ($20,188 vs $18,196; P < .001) compared with patients younger than 80 years. After adjusting for several covariates, we found that octogenarians were at significantly greater risk of experiencing in-hospital deaths (odds ratio, 4.6; P = .001), of being discharged to extended-care facilities (odds ratio, 28.4; P < .001), and of having longer lengths of stay (difference, 0.7 days; P = .002) than were patients aged 50 to 59 years.


CONCLUSIONS
At these 27 community-based facilities, the in-hospital mortality for nonemergency CABG in octogenarians was 4.7%; however, nearly 25% of surviving octogenarians were discharged to extended-care facilities.
Nallamothu
Brahmajee K
BK
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA. bnallamo@umich.edu
Saint
Sanjay
S
Eagle
Kim A
KA
Langa
Kenneth M
KM
Fendrick
A Mark
AM
Hogikyan
Robert V
RV
Kelley
Keith
K
Ramsey
Scott D
SD
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000191:economics* / Q000401:mortality*; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology