Association between older age and outcome after cardiac surgery: a population-based cohort study

Abstract

ObjectiveOctogenarians (aged ≥ 80 years) are increasingly being referred for cardiac surgery. We aimed to describe the morbidity, mortality, and health services utilization of octogenarians undergoing elective cardiac surgery.MethodsRetrospective population-based cohort study of adult patients receiving elective cardiac surgery between January 1 2004 and December 31 2009. Primary exposure was age ≥80 years. Outcomes were 30-day, 1- and 5-year mortality, post-operative complications, and ICU/hospital lengths of stay. Multi-variable logistic and Cox regression analyses were used to explore the association between older age and outcome.ResultsOf 6,843 patients receiving cardiac surgery, 544 (7.9%) were octogenarians. There was an increasing trend in the proportion of octogenarians undergoing surgery during the study period (0.3% per year, P = 0.073). Octogenarians were more likely to have combined procedures (valve plus coronary artery bypass or multiple valves) compared with younger strata (p < 0.001). Crude 30-day, 1-year and 5-year mortality for octogenarians were 3.7%, 10.8% and 29.0%, respectively. Compared to younger strata, octogenarians had higher adjusted 30-day (OR 4.83, 95%CI 1.30-17.92; P = 0.018) and 1-year mortality (OR 4.92; 95% CI, 2.32-10.46. P<0.001). Post-operative complications were more likely among octogenarians. Octogenarians had longer post-operative stays in ICU and hospital, and higher rates of ICU readmission (P < 0.001 for all). After multi-variable adjustment, age ≧ 80 years was an independent predictor of death at 30-days and 1 year.ConclusionsOctogenarians are increasingly referred for elective cardiac surgery with more combined procedures. Compared to younger patients, octogenarians have a higher risk of post-operative complications, consume greater resources, and have worse but acceptable short and long-term survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0177-6) contains supplementary material, which is available to authorized users.

Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study

“…Although elderly patients have worse early outcomes compared to younger patients, long-term outcomes for octogenarians at our institution after CABG are similar to, if not better than, the age-adjusted Canadian population. These are demonstrated by previously published reports on our cohort examining intermediate and long-term survival post-operatively for octogenarians compared to younger subjects [ 4 , 18 , 19 ].…”

Outcomes and Predictors of Mortality After Mitral Valve Surgery in High-Risk Elderly Patients: The Heidelberg Experience

“…Furthermore, mitral valve surgery remains controversial in terms of use in octogenarians on grounds of high early mortality and poor long-term survival [ 6 – 9 ]. Various studies at high-volume cardiac centers reported in-hospital and 30-day mortality up to 25% in octogenarians after mitral valve surgery [ 2 , 8 , 10 , 11 ]. One- and five-year survival rates after mitral valve replacement were reported as 67–56% and 45–29% versus 71–69% and 59–23% after mitral valve repair [ 6 , 8 ].…”

The impact of comorbidities and age on the nosocomial outcomes of patients undergoing coronary artery bypass grafting

“…Соответственно, средняя выживаемость составила 14,7 лет в возрастной группе 60-69 лет, 10,7 лет -в возрасте 70-74 года, 8,9 лет -в возрасте 75-79 лет и 7,2 года -у больных >80 лет [9]. Среди 80-летних больных годовая смертность была выше, чем у более молодых -OШ=4,92, 95% ДИ 2,32-10,46 (р<0,001) [15]. Более того, если госпитальная летальность с течением времени снижается в большинстве центров, то годовая и 5-летняя смертность меняются незначительно [8,11].…”