title: Non-elective cardiac surgery in octogenarians: Do these patients benefit in terms of clinical outcomes and quality of life?
abstract: OBJECTIVE
  The general assumption that non-elective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life (QOL) might lead to a non-justified exclusion of elderly patients from surgical treatment. The aim of the present study was to assess survival, functional outcome and quality of life of octogenarians undergoing non-elective cardiac surgery.
  
  
  METHODS
  Between 2009 and 2011, 62 consecutive octogenarians (mean age 83.5 ± 3.5 years) underwent urgent (n = 33) or emergency (n = 29) cardiac surgery. In 69% of patients, coronary artery bypass grafting was carried out, and 24% of patients underwent coronary artery bypass grafting plus valve surgery. Preoperative risk, as well as the postoperative course, was analyzed. All discharged patients were contacted to gain information about survival, functional capacity and QOL using the Barthel Mobility Index and the Short Form 12 Health Survey questionnaire. Results were compared with age-adjusted population data.
  
  
  RESULTS
  In-hospital mortality was 32.3% overall, 9.3% in urgent cases and 56.7% in emergency cases. After a mean follow-up period of 447 ± 359 days, survival of the discharged patients was 93.1% (urgent) and 76.9% (emergency), respectively. QOL measures of the survivors were equivalent to those of the general elderly population. Functional capacity, calculated with Barthel Index, was high in both groups (86 ± 13 and 81 ± 21). A total of 92% of the patients were living at home.
  
  
  CONCLUSIONS
  Although non-elective cardiac surgery in the elderly is related to high in-hospital mortality, physical and psychological recovery of the survivors is encouraging. QOL equals that of the general elderly population, and good functional status offers a highly independent life. Therefore, age per se should not disqualify patients from urgent or emergency cardiac surgery.
authors: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors: Heinz
authors: H
authors: Deschka
authors: Department of Cardiology, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors: Dirk
authors: D
authors: Müller
authors: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors: Angelo
authors: A
authors: Dell'Aquila
authors: Department of Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors: Martin
authors: M
authors: Matthäus
authors: Department of Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors: Stefan
authors: S
authors: Erler
authors: Department of Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors: Gerhard
authors: G
authors: Wimmer-Greinecker
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: cardiac surgery; emergency; octogenarians; outcomes assessment; quality of life