Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral
- S C Stoica1,
- F Cafferty1,
- J Kitcat1,
- R J F Baskett2,
- M Goddard1,
- L D Sharples1,
- F C Wells1,
- S A M Nashef1
- Correspondence to:
MrSamer A M Nashef
Papworth Hospital, Cambridge CB3 8RE, UK;
- Accepted 22 July 2005
- Published Online First 23 August 2005
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
Published Online First 23 August 2005
There are no competing interests.