M B Pliam1, A Zapolanski, C J Ryan, R E Shaw, L M Mengarelli. 1. Department of Cardiovascular Surgery, San Francisco Heart Institute, Seton Medical Center, 1900 Sullivan Avenue, Daly City, CA 94015, USA. MBPliam@compuserve.com
Abstract
BACKGROUND: Because of concerns regarding the cost-effectiveness of coronary artery surgery in patients 80 years and older, a review of a large experience is appropriate. METHODS: The records of 404 consecutive patients 80 years of age or older having isolated coronary bypass surgery (CABG) from 1985 through 1996 were reviewed. Patients were divided equally into an early and later group. Hospital mortality, complications including major arrhythmias, wound infections and separations, re-explorations, peri-operative Q-wave myocardial infarctions, major organ dysfunction, stroke, time to extubation, post-operative hospital (LOS) and intensive care unit (ICU) lengths of stay were compared. A logistic regression risk model was used to assess the relative contributions of improved technique versus more favorable patient selection. RESULTS: Comparison of the two groups revealed the following: overall hospital mortality decreased from 12.9% to 5.4% (p = 0.003), more markedly so with elective procedures where hospital mortality decreased from 8.1% to 1.2% (p = 0.04). There were significant decreases in time to extubation (2.8 +/- 9.3 days versus 1.2 +/- 2.8 days; p = 0.02), post-operative intensive care unit stay (4.9 +/- 7.1 days versus 2.9 +/- 3.7 days; p = 0.0004), post-operative complication rate (34.2% versus 22.8%; p = 0.03), and post-operative hospital length of stay (14.2 +/- 14.7 days versus 9.8 +/- 9.8 days; p = 0.0005). Post-operative stroke decreased from 7.4% to 5.9%. Mean estimated risk for the two groups was 8.2 +/- 10.2% versus 8.2 +/- 11.4%. CONCLUSION: Coronary surgery can be performed with acceptable risk in octogenarians. Results have improved over the past few years. This improvement is probably not attributable to patient selection.
BACKGROUND: Because of concerns regarding the cost-effectiveness of coronary artery surgery in patients 80 years and older, a review of a large experience is appropriate. METHODS: The records of 404 consecutive patients 80 years of age or older having isolated coronary bypass surgery (CABG) from 1985 through 1996 were reviewed. Patients were divided equally into an early and later group. Hospital mortality, complications including major arrhythmias, wound infections and separations, re-explorations, peri-operative Q-wave myocardial infarctions, major organ dysfunction, stroke, time to extubation, post-operative hospital (LOS) and intensive care unit (ICU) lengths of stay were compared. A logistic regression risk model was used to assess the relative contributions of improved technique versus more favorable patient selection. RESULTS: Comparison of the two groups revealed the following: overall hospital mortality decreased from 12.9% to 5.4% (p = 0.003), more markedly so with elective procedures where hospital mortality decreased from 8.1% to 1.2% (p = 0.04). There were significant decreases in time to extubation (2.8 +/- 9.3 days versus 1.2 +/- 2.8 days; p = 0.02), post-operative intensive care unit stay (4.9 +/- 7.1 days versus 2.9 +/- 3.7 days; p = 0.0004), post-operative complication rate (34.2% versus 22.8%; p = 0.03), and post-operative hospital length of stay (14.2 +/- 14.7 days versus 9.8 +/- 9.8 days; p = 0.0005). Post-operative stroke decreased from 7.4% to 5.9%. Mean estimated risk for the two groups was 8.2 +/- 10.2% versus 8.2 +/- 11.4%. CONCLUSION: Coronary surgery can be performed with acceptable risk in octogenarians. Results have improved over the past few years. This improvement is probably not attributable to patient selection.