OutcomesMortality and complications in elderly patients undergoing cardiac surgery
Introduction
The progressive increase in life expectancy, together with improvements in medicine, makes us witnesses to the change in some indications, especially in surgery. The aging of the Spanish society is evident, as shown by a life expectancy exceeding 75 years. According to data from the 2011 census [1], the population older than 75 years now represents 8.82% of the population registered in Spain.
Age more than 75 years, for many physicians, is a psychological barrier that identifies a population with many comorbidities that is at high risk for invasive procedures. This attitude, which is not always justified, can prevent certain patients from benefitting from all available resources. In addition, as shown in numerous studies, increased morbidity and mortality are seen when comparing the elderly population undergoing heart surgery with the younger groups [2], [3], [4], [5], [6], [7]. Therefore, the development of transaortic valve implantation since 2002 has made these techniques benefit elderly patients with high surgical risk [8].
At the same time, age has been considered a predictor of mortality and is therefore represented in risk scales used in cardiac surgery, like the EuroSCORE (European System for Cardiac Operative Risk Evaluation), which awards 1 point for each period of 5 years from 60 years; the Parsonnet score, which awards 20 points to being or older than 80 years; and Simplified Acute Physiology Score (SAPS) 3, which gives 15 points to being older than 75 years [9], [10], [11], [12].
The aim of this study was to analyze postoperative complications, mortality, and related factors of elderly patients undergoing cardiac surgery and increase knowledge about cardiac surgery in this age group.
Section snippets
Materials and methods
The registry of adult cardiac surgery platform ARIAM-Andalusia is an observational, prospective, multicenter study of all patients undergoing cardiac surgery that has progressively incorporated 11 hospitals in the autonomous community of Andalusia.
All of the patients included in the registry between March 2008 and March 2011 were analyzed. The data were collected by the physicians in charge of registration. Each hospital introduced their patients through a Web interface, developed by Coresoft,
Results
A total of 4548 patients were included in the study, with a total of 882 patients (19.4%) aged at least 75 years. Overall, mortality in the operating room was 0.7%, intra-ICU mortality was 7.7%, and 30-day mortality was 9.3% (missing data, 7%). In Table 2, we show some characteristics of patients who died and survivors. In the elderly group, mortality was 1.1%, 12%, and 15.1%, respectively, whereas in the younger patient group, it was 0.6%, and 6.7%, and 7.9%, respectively (intra-ICU and 30-day
Discussion
The results of this study show that the risk of dying was higher in patients older than 75 years than in patients younger than this age when adjusted for severity, as assessed with the variables included in the EuroSCORE, and length of CPB time.
The deleterious effect of CPB time has been generally described so that many centers use techniques such as off-pump bypass surgery [15], [16], [17]. Age is considered an independent predictor of early mortality in cardiac surgery [18], [19] and, as
Acknowledgments
The Health Council of the Junta de Andalucia and the Andalousian Program of Heart for the support of the record.
The General Secretariat of the platform ARIAM-Andalusia.
References (33)
- et al.
601 octogenarians undergoing cardiac surgery: outcome and comparative with younger age groups
Ann Thorac Surg
(1999) - et al.
Cardiac operations in patients 80 years old and older
Ann Thorac Surg
(1997) - et al.
Cirugía cardiaca en octogenarios: situación actual y perspectivas de futuro
Med Clín
(2006) Avances en la implantación percutánea de válvulas en posición aórtica
Rev Esp Cardiol
(2010)- et al.
Off-pump strategy in high risk coronary artery bypass reoperations
Mayo Clin Proc
(2007) - et al.
Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians
Can J Cardiol
(2006) - et al.
Influence of age on outcomes in patients undergoing mitral valve replacement
Ann Thorac Surg
(2002) - et al.
Cardiac surgery in the elderly: comparison of medium-term clinical outcomes in octogenarians and the elderly from 75 to 79 years
Rev Esp Cardiol
(2008) - et al.
Twenty years of cardiac surgery in patients aged 80 years and older: risks and benefits
Ann Thorac Surg
(2011) - et al.
Cirugía cardíaca en pacientes de edad avanzada
Med Intensiva
(2008)
Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral
Heart
Is mitral valve surgery safe in octogenarians?
Eur J Cardiothorac Surg
Influence of age on outcomes in patients undergoing mitral valve replacement
Ann Thorac Surg
European system for cardiac operative risk evaluation (EuroSCORE)
Eur J Cardiothorac Surg
A method of uniform stratification of risk for evaluating the results of surgery in adquirid adult heart disease
Circulation
Cited by (0)
- 1
On behalf of ARIAM cardiac surgery investigators. See Appendix for complete listing.