N M Katz1, G A Chase. 1. Department of Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
Abstract
BACKGROUND: Age has been considered an important risk factor for cardiac operations. Recent refinements have been designed to reduce cardiac, neurologic, and renal complications. METHODS: Analysis of cardiac surgical outcomes including mortality, length of stay, complications, and costs were undertaken for a consecutive series of 285 patients 70 years old and older and 568 patients younger than 70 years who underwent operation during 1991 through 1995. Management included antegrade and retrograde cold and warm blood cardioplegia, epicardial echocardiography, retrosternal dissection for reoperations, maintenance of "normal" arterial pressure, and measures to avoid renal dysfunction. Parsonnet risk stratification and multiple regression were used to account for risk factors. RESULTS: The 30-day mortality rate for elderly patients was 1.8% (5/285) and 1.8% (10/568) for patients less than 70 years old (p = not significant). The hospital mortality rate for the elderly patients was 3.2% (9/285) versus 2.5% (14/568) for the younger group (p = not significant). The frequencies of complications were not different. Over the 5-year period, length of stay decreased from 12.5 +/- 1.5 days to 8.9 +/- 0.9 days for patients 70 years old and older and from 11.5 +/- 0.1 to 6.4 +/- 0.3 days for patients less than 70 years old. Hospital charges for the elderly group were 13% higher. CONCLUSIONS: Modern cardiac surgical techniques and clinical practices have reduced the importance of the age factor.
BACKGROUND: Age has been considered an important risk factor for cardiac operations. Recent refinements have been designed to reduce cardiac, neurologic, and renal complications. METHODS: Analysis of cardiac surgical outcomes including mortality, length of stay, complications, and costs were undertaken for a consecutive series of 285 patients 70 years old and older and 568 patients younger than 70 years who underwent operation during 1991 through 1995. Management included antegrade and retrograde cold and warm blood cardioplegia, epicardial echocardiography, retrosternal dissection for reoperations, maintenance of "normal" arterial pressure, and measures to avoid renal dysfunction. Parsonnet risk stratification and multiple regression were used to account for risk factors. RESULTS: The 30-day mortality rate for elderly patients was 1.8% (5/285) and 1.8% (10/568) for patients less than 70 years old (p = not significant). The hospital mortality rate for the elderly patients was 3.2% (9/285) versus 2.5% (14/568) for the younger group (p = not significant). The frequencies of complications were not different. Over the 5-year period, length of stay decreased from 12.5 +/- 1.5 days to 8.9 +/- 0.9 days for patients 70 years old and older and from 11.5 +/- 0.1 to 6.4 +/- 0.3 days for patients less than 70 years old. Hospital charges for the elderly group were 13% higher. CONCLUSIONS: Modern cardiac surgical techniques and clinical practices have reduced the importance of the age factor.
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