title: Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden?
abstract: OBJECTIVE
  In accordance with the rising prevalence of octogenarians undergoing cardiac surgery, these patients utilize an increasing portion of intensive care unit (ICU) capacities, provoking economic and ethical concerns. In this study, we evaluated the outcomes and costs generated by the prolonged postoperative ICU treatment of octogenarians.
  
  
  METHODS
  Between July 2009 and August 2010, 109 of 1063 patients required ICU treatment of at least 5 days after cardiac surgery. Patients were retrospectively assigned to either Group A (age <80, n = 86) or Group B (age ≥80, n = 23). Operative risk, mortality, length and costs of ICU treatment were analysed and compared. After 1 year, survival, quality of life (QOL) and functional status were assessed.
  
  
  RESULTS
  Hospital mortality was 31.4% in Group A and 56.5% in Group B. Survivals of discharged patients after 1 year were 83% (Group A) and 80% (Group B), respectively. Log EuroSCORE I of octogenarians was significantly higher (30 ± 17 vs 20 ± 16, P < 0.001). No significant differences (Group A vs Group B) were found between the groups concerning length of ICU treatment (20 ± 21 vs 16 ± 14 days, P = 0.577) or costs (27 205 ± 29 316€ vs 21 821 ± 16 259€, P = 0.812). Functional capacity, calculated by using Barthel index, was high (Group A: 87 ± 22 and Group B: 67 ± 31, P = 0.108) and did not differ significantly between groups. QOL, measured with the short form-12 health survey, did not differ significantly between groups (physical health summary score: P = 0.27; mental health score: P = 0.885) and was comparable with values of the age-adjusted general population.
  
  
  CONCLUSIONS
  Presented data propose that advanced age is correlated with a higher mortality, but not with prolonged ICU treatment or higher costs after cardiac surgery. Considering the encouraging functional status and QOL of the survivors, the financial burden caused by octogenarians is justified.
authors.affiliation: Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen, Germany. deschkaheinz@hotmail.com
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.forename: Romy
authors.initials: R
authors.lastname: Schreier
authors.forename: Lemir
authors.initials: L
authors.lastname: El-Ayoubi
authors.forename: Stefan
authors.initials: S
authors.lastname: Erler
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.forename: Aiman
authors.initials: A
authors.lastname: Alken
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics*; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Cardiac surgery; Intensive care; Octogenarians; Outcomes; Quality of life