Discharge to home rates are significantly lower for octogenarians undergoing coronary artery bypass graft surgery.
BACKGROUND
The incidence of coronary artery bypass graft surgery (CABG) performed in elderly patients has been increasing over recent years. We sought to evaluate clinical outcomes of octogenarians undergoing CABG using an audited state-wide mandatory database.


METHODS
New York State Department of Health's Cardiac Reporting System was analyzed from 1998 to 2002. In all, 88,154 patients undergoing isolated CABG were identified. Patients were divided into four age groups: less than 50 years (group 1, n = 6,527), 50 to 64 years (group 2, n = 30,088), 65 to 79 years (group 3, n = 43,369), and 80 years and above (group 4, n = 8,170).


RESULTS
Of all patients, 9.3% were octogenarians. In addition to marginally worse coronary artery disease, octogenarians generally manifested a higher incidence of preoperative risk factors such as cerebrovascular disease, peripheral vascular disease, and congestive heart failure compared with younger patients at baseline. Both length of hospital stay and in-hospital mortality rate were significantly higher among octogenarians. The incidence of postoperative complications was higher among octogenarians. Multivariate analysis demonstrated renal failure requiring dialysis (odds ratio [OR] = 4.4), myocardial infarction within 6 hours before surgery (OR = 3.6), chronic obstructive pulmonary disease (OR = 1.7), congestive heart failure at admission (OR = 1.7), emergent operation (OR = 1.6), Canadian Cardiovascular Society functional class IV (OR = 1.5), hypertension (OR = 1.4), and low ejection fraction (OR = 0.98) to be significant independent predictors of in-hospital mortality of octogenarians. Discharge to home rates were significantly lower for octogenarians.


CONCLUSIONS
Although early outcomes in octogenarians are acceptable, these factors alone are not sufficient to reflect overall success of CABG in these patients, given the strikingly lower discharge to home rates. Attention to full functional recovery in octogenarians is essential.
Bardakci
Hasmet
H
Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University-New York Presbyterian Hospital, New York, New York 10032, USA.
Cheema
Faisal H
FH
Topkara
Veli K
VK
Dang
Nicholas C
NC
Martens
Timothy P
TP
Mercando
Michelle L
ML
Forster
Catherine S
CS
Benson
Ariel A
AA
George
Isaac
I
Russo
Mark J
MJ
Oz
Mehmet C
MC
Esrig
Barry C
BC
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome