Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery.
OBJECTIVE
To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery.


METHODS
Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years.


METHODS
One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who underwent cardiac surgery.


METHODS
A university-affiliated tertiary care center.


RESULTS
Compared to septuagenarians, octogenarians were more likely to be widowed (p < or = 0.001) and to have had preoperative strokes (p < or = 0.05) but were less likely to have diabetes mellitus (p < or = 0.001). They were less likely to have undergone mitral valve surgery (p < or = 0.01) but were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p < or = 0.001). The hospital mortality rate was 6% in the younger group and 9% in the older group (odds ratio, 1.5; 95% confidence interval [CI], 0.5 to 4.5; p > 0.05). In patients undergoing isolated CABG, the mortality rate was 1.4% in the septuagenarians and 8.2% in the octogenarians (odds ratio, 6.2; 95% CI, 0.7 to 52.7; p = 0.12). Despite similar ICU, postoperative, and total lengths of stay, the median hospital direct variable cost was 35% higher for the octogenarians. At late follow-up, octogenarians had lower levels of physical functioning and general health but otherwise had levels of function that were similar to those of septuagenarians.


CONCLUSIONS
Cardiac surgery can be performed in the elderly with good hospital and late functional results, but at a higher hospital cost than that for younger patients.
Engoren
Milo
M
Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA. engoren@pol.net
Arslanian-Engoren
Cynthia
C
Steckel
Donna
D
Neihardt
Julie
J
Fenn-Buderer
Nancy
N
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000379:methods* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods / Q000401:mortality; D003362:Cost-Benefit Analysis; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods / Q000401:mortality; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome