Functional Status May Serve as a Predictor of CABG Surgery Outcome in the Elderly Patient

Abstract

Despite the growing number of elderly patients undergoing coronary artery bypass graft (CABG) surgery, no study addressing postoperative outcome from the perspective of preoperative functional status has been reported to date. The present investigation therefore undertook to determine, among elderly individuals matched for cardiac status, whether patients with poor functional status have a greater risk of mortality and morbidity following CABG surgery than those with good functional status. Retrospective preoperative and postoperative geriatric functional assessment using a standardized questionnaire was performed on 46 consecutive patients who had undergone CABG in 1994 at age 65 or older. Preoperative functional status was comprised of pre-anginal functional status (before angina limited physical activity) and anginal functional status (during which angina was a noticeable limiting factor). CABG outcome was recorded in terms of postoperative assessment of functional status, morbidity, and mortality. The results of statistical analysis revealed that both pre-anginal and anginal functional status were sensitive predictors of post-operative functional status (p < 0.005 and p < 0.001, respectively). In addition, the presence of comorbidities typically used in the screening of candidates was found to be a sensitive predictor of outcome (p < 0.02). However, the presence of comorbidities was not significantly linked to poor preoperative functional status (p > 0.05), indicating that these two predictors may screen for different elderly sub-populations at high risk for negative outcome of CABG. If confirmed by further studies of elderly patients undergoing CABG, these results suggest a new and important role for functional status as a predictor of CABG outcome in the elderly. Furthermore, these results may be useful toward the development of a reliable tool in screening for high risk of poor outcome among elderly candidates for CABG surgery.