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Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral
  1. S C Stoica1,
  2. F Cafferty1,
  3. J Kitcat1,
  4. R J F Baskett2,
  5. M Goddard1,
  6. L D Sharples1,
  7. F C Wells1,
  8. S A M Nashef1
  1. 1Papworth Hospital, Cambridge, UK
  2. 2Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to:
    MrSamer A M Nashef
    Papworth Hospital, Cambridge CB3 8RE, UK; sam.nashef{at}papworth.nhs.uk

Abstract

Objective: To examine short and long term outcomes of octogenarians having heart operations and to analyse the interaction between patient and treatment factors.

Methods: Multivariate analysis of prospectively collected data and a survival comparison with an age and sex matched national population. The outcomes were base in-hospital mortality, risk stratified by logistic EuroSCORE (European system for cardiac operative risk evaluation), and long term survival.

Results: 12 461 consecutive patients (706 over 80 years) operated on between 1996 and 2003 in a regional UK unit were studied. Octogenarians more often had impaired ventricular function, pulmonary hypertension, and valve operations. They also included a higher proportion of women, had a higher serum creatinine concentration, and had a trend towards more unstable angina. Younger patients had a higher prevalence of previous cardiac operation, previous myocardial infarction, and diabetes. The in-hospital mortality rate was 3.9% for all patients (EuroSCORE predicted 6.1%, p < 0.001) and 9.8% for octogenarians (predicted 14.1%, p  =  0.002). Long bypass time and non-elective surgery increased the risk of death above EuroSCORE prediction in both groups. A greater proportion of octogenarians stayed in intensive care more than 24 hours (37% v 23%, p < 0.001). Long term survival was significantly better in the study patients than in a general population with the same age–sex distribution (survival rate at five years 82.1% v 55.9%, p < 0.001).

Conclusions: Cardiac surgery in a UK population of octogenarians produced excellent results. Elective referrals should be encouraged in all age groups.

  • APPROACH, Alberta provincial project for outcome assessment in coronary heart disease
  • CI, confidence interval
  • EuroSCORE, European system for cardiac operative risk evaluation
  • TIME, trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary artery disease
  • cardiac surgery
  • octogenarians
  • EuroSCORE
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Footnotes

  • Published Online First 23 August 2005

  • There are no competing interests.

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