Early and Late Outcomes of Cardiac Surgery in Octogenarians

Zingone, Bartolo; Gatti, Giuseppe; Rauber, Elisabetta; Tiziani, Paola; Dreas, Lorella; Pappalardo, Aniello; Benussi, Bernardo; Spina, Amedeo

doi:10.1016/j.athoracsur.2008.10.011

Cited by 82 publications

(67 citation statements)

References 29 publications

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“…2,3 Nevertheless, elderly patients have consistently been shown to derive sizeable benefits from cardiac surgery. 4,5 This risk-benefit dichotomy renders the process of selecting appropriate elderly patients particularly challenging for the cardiac surgeon. Numerous cardiac surgery risk scores which incorporate clinical and demographic variables have been developed to predict operative risk and help guide patient selection in cardiac surgery.…”

mentioning

confidence: 99%

Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity

Afilalo

Mottillo²,

Eisenberg³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

365

285

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Background-Cardiac surgery risk scores perform poorly in elderly patients, in part because they do not take into account frailty and disability which are critical determinants of health status with advanced age. There is an unmet need to combine established cardiac surgery risk scores with measures of frailty and disability to provide a more complete model for risk prediction in elderly patients undergoing cardiac surgery. Methods and Results-This was a prospective, multicenter cohort study of elderly patients (Ն70 years) undergoing coronary artery bypass and/or valve surgery in the United States and Canada. Four different frailty scales, 3 disability scales, and 5 cardiac surgery risk scores were measured in all patients. The primary outcome was the STS composite end point of in-hospital postoperative mortality or major morbidity. A total of 152 patients were enrolled, with a mean age of 75.9Ϯ4.4 years and 34% women. Depending on the scale used, 20 -46% of patients were found to be frail, and 5-76% were found to have at least 1 disability.

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mentioning

confidence: 99%

Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity

Afilalo

Mottillo²,

Eisenberg³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

365

285

View full text Add to dashboard Cite

show abstract

“…Our data shows a lower survival rate than these data, but a strict meaningful comparison is difficult from other nationally representative studies because of different patient selection and the preoperative patients' co-morbid state. It is well known that emergency surgery is largely related to operative results [23,24]. Specifically in the case of elderly patients who had undergone surgery in an emergency status, inferior results have previously been reported for late outcomes [22,25].…”

Section: 4% Vs 440%)mentioning

confidence: 99%

Clinical Results of Cardiovascular Surgery in the Patients Older than 75 Years

Kim

Park

Isamukhamedov³

et al. 2014

Korean J Thorac Cardiovasc Surg

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Background:The balance of the risks and the benefits of cardiac surgery in the elderly remains a major concern.We evaluated the early and mid-term clinical results of patients aged over 75 years who underwent major cardiovascular surgery. Methods: Two hundred and fifty-one consecutive patients, who underwent cardiac surgery at Seoul National University Bundang Hospital between July 2003 and June 2011, were included in this study (mean age, 78.7±3.4 years; male:female=130:121). Elective surgery was performed in 112 patients, urgent in 90, and emergency in 49. Results: Early mortality was 12.7% (32/251). Follow-up completion was 100%, and the mean follow-up duration was 2.8±2.2 years. Late mortality was 24.2% (53/219). There were 283 readmissions in a total of 109 patients after discharge. However, the reason for readmission was related more to non-cardiac factors (71.3%) than to cardiac factors. The overall survival estimates were 79.2% at the 1-year follow-up and 58.4% at the 5-year follow-up. Patients who underwent elective surgery had a lower early mortality rate (elective, 4.5%; urgent, 13.3%; emergency, 30.6%) and better overall survival rate than those that underwent urgent or emergency surgery (p ＜0.001). Conclusion: The timing of cardiac surgery was found to be an independent risk factor for early and late mortality. Thus, earlier referral and intervention may improve operative results. Further, comprehensive coordinated postoperative care is needed for other comorbid problems in aged patients.

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“…1 Studies have shown that patients aged 80 and over undergoing cardiac surgery have a longer length of stay, higher morbidity and higher 30-day mortality than younger patients 2 with one study finding a 30-day mortality of 10.6% for those over 80. 3 This has a significant impact upon resource utilisation and surgical throughput and also may influence the decision of patients to proceed with surgery.…”

Section: Introductionmentioning

confidence: 99%

Critical care admissions in a cardiothoracic hospital: Mortality in patients aged over 80 years

Quarterman

Kirmani

Al-Rawi

2015

Journal of the Intensive Care Society

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Background: Cardiac surgery is increasingly performed on patients aged 80 years and over. Previous studies have shown an associated longer length of hospital stay and higher morbidity and mortality. Our aim was to establish whether an increased mortality was demonstrated in patients aged over 80 undergoing surgery in our centre, and the impact of age upon critical care and hospital stay, and 30-day and 6-month survival. Methods: Over a 12-month period, 2042 critical care episodes were examined collectively and divided into those undergoing thoracic and cardiac surgery. Propensity matching of 216 patients who underwent cardiac surgery was performed for parameters including Acute Physiology And Chronic Health Evaluation (APACHE) II and Intensive Care National Audit and Research Centre score. Results: Of the admissions studied, 1784 were of patients under 80 years of age, and 258 over 80. Thirty-day mortality of those aged over 80 was significantly higher (8.9% vs. 3.8%, p < 0.0001), although the number of days of each level of organ support and total duration of critical care stay was not significantly different. Propensity matching of cardiac surgery patients indicated a longer length of hospital stay in those aged over 80, but no significant difference in length of critical care stay or mortality at six months. Conclusions: As previously demonstrated, we found an increased mortality in the older patient group. Following propensity matching, there was no significant difference in 30-day or 6-month mortality. Older patients must be fitter than their younger peers to compensate for the effects of age on APACHE II score. Even when this is taken into consideration, cardiothoracic operations appear to be safe in patients aged over 80.

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Early and Late Outcomes of Cardiac Surgery in Octogenarians

Cited by 82 publications

References 29 publications

Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity

Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity

Clinical Results of Cardiovascular Surgery in the Patients Older than 75 Years

Critical care admissions in a cardiothoracic hospital: Mortality in patients aged over 80 years

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