Octogenarians Undergoing Coronary Artery Bypass Graft Surgery: Resource Utilization, Postoperative Mortality, and Morbidity

Scott, Bharathi H.; Seifert, F.; Grimson, Roger; Glass, Peter S. A.

doi:10.1053/j.jvca.2005.03.030

Cited by 104 publications

(77 citation statements)

References 20 publications

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“…298,1126 Retrospective studies have observed a substantially higher in-hospital mortality rate among octogenarians than among younger patients. [1127][1128][1129][1130] A report from the National Cardiovascular Network of outcomes in 67 764 patients undergoing cardiac surgery, of whom 4743 were octogenarians, showed that the in-hospital mortality rate for the octogenarians was substantially higher (3.0% versus 8.1%; PϽ0.001). 1127 Several retrospective studies of patients undergoing CABG have reported a higher incidence of neurological complications, renal failure, respiratory failure, and gastrointestinal complications among octogenarians than among younger subjects.…”

Section: Elderlymentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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Section: Elderlymentioning

confidence: 99%

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

et al. 2011

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“…Patients with a low risk of complications are being scheduled for surgery before patients with a high risk. [5][6][7][8][9][10][11][12][13] Various prediction models have been developed to preoperatively identify patients with an increased risk for postoperative complications and prolonged ICU stay. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Interestingly, all of these prediction models were derived from samples including different patients, as reflected by the different distributions of patient and outcome characteristics.…”

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confidence: 99%

Prediction Models for Prolonged Intensive Care Unit Stay After Cardiac Surgery

et al. 2010

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Background-Several models have been developed to predict prolonged stay in the intensive care unit (ICU) after cardiac surgery. However, no extensive quantitative validation of these models has yet been conducted. This study sought to identify and validate existing prediction models for prolonged ICU length of stay after cardiac surgery. Methods and Results-After a systematic review of the literature, the identified models were applied on a large registry database comprising 11 395 cardiac surgical interventions. The probabilities of prolonged ICU length of stay based on the models were compared with the actual outcome to assess the discrimination and calibration performance of the models. Literature review identified 20 models, of which 14 could be included. Of the 6 models for the general cardiac surgery population, the Parsonnet model showed the best discrimination (area under the receiver operating characteristic curveϭ0.75 [95% confidence interval, 0.73 to 0.76]), followed by the European system for cardiac operative risk evaluation (EuroSCORE) (0.71 [0.70 to 0.72]) and a model by Huijskes and colleagues (0.71 [0.70 to 0.73]). Most of the models showed good calibration. Conclusions-In this validation of prediction models for prolonged ICU length of stay, 2 widely implemented models (Parsonnet, EuroSCORE), although originally designed for prediction of mortality, were superior in identifying patients with prolonged ICU length of stay. (Circulation. 2010;122:682-689.)Key Words: cardiovascular diseases Ⅲ complications Ⅲ epidemiology Ⅲ risk factors Ⅲ surgery I n the past decades, mortality during or shortly after cardiac surgery has decreased. 1 However, morbidity has increased, 2 mainly because cardiac surgery is increasingly utilized in older and more vulnerable patients. This often results in more complications after surgery and potential reduction in quality of life. [3][4][5] One method of assessing complications occurring directly after cardiac surgery is a prolonged stay in the intensive care unit (ICU). 6 -9 Prolonged ICU stay also leads to incremental use of resources. In practice, prediction models are being used for efficient use of ICU resources. Patients with a low risk of complications are being scheduled for surgery before patients with a high risk. [5][6][7][8][9][10][11][12][13] Various prediction models have been developed to preoperatively identify patients with an increased risk for postoperative complications and prolonged ICU stay. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Interestingly, all of these prediction models were derived from samples including different patients, as reflected by the different distributions of patient and outcome characteristics. Hence, which model should be preferred in which situation is still unclear. Recently, in a qualitative review, Messaoudi and colleagues 14 reviewed 13 of these prediction models by comparing their published prognostic values for predicting ICU stay. They found that the 13 different prediction models indeed used...

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“…30,31 In studies published from 2000 to 2007, operative mortality was up to 2-fold higher in octogenarians, and the rate of discharge to home was half that of younger patients. [32][33][34] Average intensive care unit and total hospital length of stay are also longer in older patients.…”

Section: Current Recommendationsmentioning

confidence: 99%

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

Rich¹,

Chyun²,

Skolnick³

et al. 2016

Circulation

164

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Abstract-The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results ofCirculation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000380The American Heart Association, the American College of Cardiology, and the American Geriatrics Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Copies: This document is available on the World Wide Web sites of the American Heart Association (professional.heart.org) and the American College of Cardiology (www.acc.org). A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer ...

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Octogenarians Undergoing Coronary Artery Bypass Graft Surgery: Resource Utilization, Postoperative Mortality, and Morbidity

Cited by 104 publications

References 20 publications

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Prediction Models for Prolonged Intensive Care Unit Stay After Cardiac Surgery

Knowledge Gaps in Cardiovascular Care of the Older Adult Population

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