November 21, 2005
Age affects cardiac surgery outcome
NEW YORK (Reuters Health) - Compared with younger patients
-- even those with similar histories -- patients in their 80s
who undergo coronary artery bypass grafting (CABG) or valve
replacement surgery are at greater risk for postoperative
complications and mortality, the results of a new study
Some recent studies have found that octogenarians who
undergo cardiac surgery have good outcomes, while other studies
have suggested an increased risk compared with their younger
Johnson, from Good Samaritan Hospital in Cincinnati, Ohio, and
associates conducted a study of patients who underwent CABG or
valve replacement between 1993 and 2001. Included were 522
patients between 80 and 89 years old, and 7,204 patients
between 18 and 79 years.
As reported in the Archives of Surgery, the rate of
in-hospital mortality was higher among octogenarians (8 percent
versus 2 percent), as were neurologic complications (12 percent
versus 5 percent), the need for a second surgery to treat
bleeding (5 percent versus 2 percent), respiratory
complications (8 percent versus 4 percent), kidney
complications (8 percent versus 4 percent), and the length of
hospitalization (8.74 versus 6.72 days).
After factoring in the influence of demographic factors,
co-existing illnesses and other risk factors, age alone
increased the risk of death by 72 percent, neurologic
complications by 51 percent and need to undergo a second
surgery by 49 percent.
"An increasing number of octogenarians undergoing coronary
revascularization or valve surgery are certain to strain an
already burdened health care system," Johnson's team points
They add: "It is therefore incumbent on researchers to
develop more refined algorithms to predict postoperative
outcomes. As this study indicates, age should be considered a
component of any such algorithm."
SOURCE: Archives of Surgery, November 2005.