title: Perioperative care in elderly cardiac surgery patients.
abstract: BACKGROUND
  Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin.
  
  
  OBJECTIVE
  To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients.
  
  
  METHODS
  The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009-2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients.
  
  
  RESULTS
  The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality).
  
  
  CONCLUSIONS
  The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium.
authors.affiliation: Department of Anesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Kucewicz-Czech
authors.affiliation: Department of Cardiac Anesthesiology and Intensive Care, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kiecak
authors.affiliation: Department of Cardiac Anesthesiology and Intensive Care, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Urbańska
authors.affiliation: Department of Cardiac Anesthesiology and Intensive Care, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Maciejewski
authors.affiliation: Department of Cardiac Anesthesiology and Intensive Care, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Kaliś
authors.affiliation: Department of Cardiac Anesthesiology and Intensive Care, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Pakosiewicz
authors.affiliation: Department of Anesthesiology and Intensive Care with Cardiac Monitoring, Upper Silesian Medical Centre, Katowice, Poland.
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Kołodziej
authors.affiliation: Department of Cardiac Anesthesiology and Intensive Care, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Knapik
authors.affiliation: Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Przybylski
authors.affiliation: Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
keywords: cardiac surgery; delirium; elderly; mechanical ventilation