Elsevier

Journal of Critical Care

Volume 28, Issue 4, August 2013, Pages 397-404
Journal of Critical Care

Outcomes
Mortality and complications in elderly patients undergoing cardiac surgery

https://doi.org/10.1016/j.jcrc.2012.12.011Get rights and content

Abstract

Purpose

The purpose of the study was to analyze postoperative complications, mortality, and related factors of elderly patients undergoing cardiac surgery.

Methods

An observational, retrospective, and multicenter study of cardiac surgery patients, obtained from the ARIAM registry, was performed between 2008 and 2011. Clinical-surgical data, postoperative complications, and mortality were analyzed in a group of patients older than 75 years and in a younger group.

Results

A total of 4548 patients were analyzed, with 882 (19.4%) patients at least 75 years old. Elderly patients had worse functional status (New York heart Association class) and comorbidities. The complication rate was higher in the elderly group (40.4% and 33.5%, respectively; P = .0001). Mortality in the elderly was 1.1%, 12%, and 15.1% (during surgery, intensive care unit [ICU], and 30-day mortality, respectively). Thirty-day mortality in elderly patients was higher when adjusted for EuroSCORE (European System for Cardiac Operative Risk Evaluation) and cardiopulmonary bypass time.

The interaction between multiorgan dysfunction syndrome (MODS) and age more than 75 years was assessed by logistic regression, obtaining an odds ratio of 9.27 (5.88-14.60) for younger patients and 29.44 (12.22-70.94) for elderly patients who died during the ICU stay.

Conclusions

Age more than 75 years is an independent risk factor for ICU mortality when adjusted for EuroSCORE and cardiopulmonary bypass time. Elderly patients also have a higher rate of complications during ICU stay. Elderly patients develop MODS more frequently and present a higher mortality rate than younger patients with MODS.

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)

  • Revisión del Padrón municipal 2011. Datos a nivel nacional. [in internet]. 2011 Jan. [cited 10 May 2012]. Available at:...
  • S.C. Stoica et al.

    Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral

    Heart

    (2006)
  • J. Nagendran et al.

    Is mitral valve surgery safe in octogenarians?

    Eur J Cardiothorac Surg

    (2005)
  • R.H. Metha et al.

    Influence of age on outcomes in patients undergoing mitral valve replacement

    Ann Thorac Surg

    (2002)
  • S.A. Nashef et al.

    European system for cardiac operative risk evaluation (EuroSCORE)

    Eur J Cardiothorac Surg

    (1999)
  • V. Parsonnet et al.

    A method of uniform stratification of risk for evaluating the results of surgery in adquirid adult heart disease

    Circulation

    (1989)
  • Cited by (0)

    1

    On behalf of ARIAM cardiac surgery investigators. See Appendix for complete listing.

    View full text