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 suggest.

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 counterparts.

To further investigate this situation, Dr. W. Michael 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 out.

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.