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Ann Thorac Surg 1985;39:426-432
© 1985 The Society of Thoracic Surgeons

Articles

Mortality, Morbidity, and Cost-Accounting Related to Coronary Artery Bypass Graft Surgery in the Elderly

Arthur J. Roberts, M.D.*, Dennis D. Woodhall, M.D., C. Richard Conti, M.D., Dennard W. Ellison, B.A., Ronald Fisher, Cynthia Richards, R.N., Ronald G. Marks, Ph.D., Daniel G. Knauf, M.D., James A. Alexander, M.D.

From the Departments of Surgery, Medicine, and Biostatistics, Divisions of Cardiothoracic Surgery and Cardiovascular Medicine, J. Hillis Miller Health Center, University of Florida Medical School, Gainesville, FL

Accepted for publication July 2, 1984.

* Address reprint requests to Dr. Roberts, Chairman, Department of Cardiothoracic Surgery, Boston University Medical Center, 75 E Newton St, Boston, MA 02118

The purpose of this study was to document early mortality, perioperative complication rate, duration of hospitalization, and costs related to coronary artery bypass graft (CABG) surgery in the elderly. Arbitrarily, elderly patients were defined by age greater than or equal to 65 years; younger patients were less than or equal to 60 years old. A detailed list of specific perioperative complications was analyzed.

Early (30-day) mortality was similar between groups, while 120-day mortality was higher among elderly compared with younger patients (7.6% versus 1.3%; p = 0.05). The number of elderly patients with 1 or more complications was also higher than among the younger patients (62% versus 43%; p = 0.05). When the incidences of atrial arrhythmias and transient psychoses were considered minor complications and excluded from consideration, the incidence of major complications was higher in the elderly: 41 major events among 76 younger surviving patients compared with 89 major complications in 61 older surviving patients (p = 0.001). Time spent in the intensive care unit and the duration of postoperative hospitalization were also greater in the elderly (p = 0.01 and p = 0.001, respectively). Finally, the elderly group incurred greater costs than the younger patients (p = 0.03).

The likelihood of increased perioperative morbidity in elderly patients is documented in this study. Also, it appears that the increased frequency of complications in elderly patients is associated with a longer hospital stay and greater financial expense. Consequently, the careful preoperative evaluation of these patients, including cautious patient selection, assumes greater importance. After CABG procedures, the highly symptomatic elderly patient may experience dramatic relief of symptoms. Another goal of such surgery should be to optimize the quality of life. If these aims can be achieved, the greater utilization of hospital resources and the expense associated with CABG in the elderly may be justified.




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