title: The impact of age and severity of comorbid illness on outcomes after isolated aortic valve replacement for aortic stenosis.
abstract: OBJECTIVE
  This study examines outcomes in a national sample of patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis, with particular focus on advanced-age patients and those with extreme severity of comorbid illness (SOI).
  
  
  METHODS
  Data were obtained from the Nationwide Inpatient Sample and included all patients undergoing AVRs performed from January 1, 2006 to December 31, 2008. Patients with major concomitant cardiac procedures, as well as those aged, 20 years, and those with infective endocarditis or aortic insufficiency without aortic stenosis, were excluded from analysis. The analysis included 13,497 patients. Patients were stratified by age and further stratified by All Patient Refined Diagnosis Related Group SOI into mild/moderate, major, and extreme subgroups.
  
  
  RESULTS
  Overall in-hospital mortality was 2.96% (n=399); in-hospital mortality for the ≥80-year-old group (n=139, 4.78%) was significantly higher than the 20- to 49-year-old (n=9, 0.84%, P<0.001) or 50- to 79-year-old (n=251, 2.64%, P<0.001) groups. In-hospital mortality was significantly higher in the extreme SOI group (n=296, 15.33%) than in the minor/moderate (n=22, 0.35%, P<0.001) and major SOI groups (n=81, 1.51%, P<0.001). Median in-hospital costs in the mild/moderate, major, and extreme SOI strata were $29,202.08, $36,035.13, and $57,572.92, respectively.
  
  
  CONCLUSIONS
  In the minor, moderate, and major SOI groups, in-hospital mortality and costs are low regardless of age; these groups represent >85% of patients undergoing isolated AVR for aortic stenosis. Conversely, in patients classified as having extreme SOI, surgical therapy is associated with exceedingly high inpatient mortality, low home discharge rates, and high resource utilization, particularly in the advanced age group.
authors.affiliation: Barnabas Health Hospital, Newark/Livingston, NJ, USA ; Barnabas Health Cardiovascular Clinical Research Center, Newark, NJ, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Iribarne
authors.affiliation: Barnabas Health Cardiovascular Clinical Research Center, Newark, NJ, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Chen
authors.affiliation: Barnabas Health Cardiovascular Clinical Research Center, Newark, NJ, USA.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Karanam
authors.affiliation: Barnabas Health Cardiovascular Clinical Research Center, Newark, NJ, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Pettit
authors.affiliation: Department of Cardiovascular Surgery, S Croce Hospital, Cuneo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: University of Chicago, Chicago, IL, USA.
authors.forename: Atman P
authors.initials: AP
authors.lastname: Shah
authors.affiliation: Barnabas Health Hospital, Newark/Livingston, NJ, USA ; Barnabas Health Cardiovascular Clinical Research Center, Newark, NJ, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Saunders
keywords: cardiac surgery; outcomes; risk stratification