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Ann Thorac Surg 2001;71:591-596
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Cardiac surgery in the octogenarian: evaluation of risk, cost, and outcome

G. James Avery, II, MDa, S. Jill Ley, RNa, J. Donald Hill, MDa, James J. Hershon, MDa, Stuart E. Dick, MPHb

a Department of Cardiac Surgery, Clinical Resource Management, California Pacific Medical Center, San Francisco, California, USA
b Department of The Research Institute, California Pacific Medical Center, San Francisco, California, USA

Accepted for publication May 11, 2000.

Address reprint requests to Dr Avery, 2100 Webster St, Suite 320, San Francisco, CA 94115
e-mail: leyj{at}sutterhealth.org

Background. Nationwide, cardiac surgery is being performed more frequently in patients aged 80 years and older.

Methods. One hundred four octogenarians undergoing a variety of heart–lung procedures were prospectively studied between 1995 and 1998 for comparison with similar patients aged 65 to 75 years (n = 351).

Results. Octogenarians were more likely to be of female gender, and be nondiabetic than the younger group. The 30-day mortality rate for patients aged 65 to 75 years was 3.4% (12 of 351 patients), versus 13.5% (14 of 104) for patients aged 80+ (p = 0.0004), which ranged from 2% (1 of 50) in nonemergent coronary artery bypass grafting to 75% (3 of 4) in double valve procedures. Complications occurring more frequently in octogenarians were severe low output state, reintubation, and atrial fibrillation. Elders experienced a longer intensive care (69.2 versus 43.3 hours, p = 0.002) and postoperative stay (10.09 versus 7.45 days, p = 0.001), and were discharged to a skilled nursing facility more often than younger patients (47% versus 21.1%, p = 0.0001). Total direct costs were $4,818 higher in the octogenarian group (p = 0.0007).

Conclusions. Although emergency operations and complex procedures carried high risks for the octogenarian, the majority of these patients can be offered operation with short-term morbidity, mortality, and resource use that only modestly exceeds that of younger patients.




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