Chest
Volume 122, Issue 4, October 2002, Pages 1309-1315
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Clinical Investigations
Cost, Outcome, and Functional Status in Octogenarians and Septuagenarians after Cardiac Surgery

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Study objectives

To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery.

Design

Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years.

Patients

One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who underwent cardiac surgery.

Setting

A university-affiliated tertiary care center.

Measurements and results

Compared to septuagenarians, octogenarians were more likely to be widowed (p ≤ 0.001) and to have had preoperative strokes (p ≤ 0.05) but were less likely to have diabetes mellitus (p ≤ 0.001). They were less likely to have undergone mitral valve surgery (p ≤ 0.01) but were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p ≤ 0.001). The hospital mortality rate was 6% in the younger group and 9% in the older group (odds ratio, 1.5; 95% confidence interval [CI], 0.5 to 4.5; p > 0.05). In patients undergoing isolated CABG, the mortality rate was 1.4% in the septuagenarians and 8.2% in the octogenarians (odds ratio, 6.2; 95% CI, 0.7 to 52.7; p = 0.12). Despite similar ICU, postoperative, and total lengths of stay, the median hospital direct variable cost was 35% higher for the octogenarians. At late follow-up, octogenarians had lower levels of physical functioning and general health but otherwise had levels of function that were similar to those of septuagenarians.

Conclusion

Cardiac surgery can be performed in the elderly with good hospital and late functional results, but at a higher hospital cost than that for younger patients.

Section snippets

Materials and Methods

This study was approved by the institutional review board of a university-affiliated, tertiary care medical center. The hospital's computerized medical information system was queried for all patients 70 to 89 years of age who had undergone cardiac surgery between January 1, 1998, and December 31, 1999. All patients who were 80 to 89 years old (cases) and an equal number of randomly selected patients who were 70 to 79 years old (control subjects) from the same time period had their charts

Results

One hundred three patients in each group underwent cardiac surgery and were studied (Table 1). Octogenarians were more likely to be widowed (p ≤ 0.001), while septuagenarians were more likely to be married (p < 0.01). Octogenarians were more likely to have had preoperative strokes (p = 0.05) but were less likely to have diabetes mellitus (p < 0.001). Other comorbidities were distributed similarly. Octogenarians were less likely to have undergone mitral valve surgery (p = 0.01) but were more

Discussion

Despite a higher prevalence of preoperative stroke, which is a risk factor for hospital mortality after cardiac surgery, we found that octogenarians underwent cardiac surgery with hospital survival rates and complication rates that were similar to those of septuagenarians but at a higher hospital cost. Our hospital mortality rate (8.2% in octogenarians) is similar to or lower (5.6 to 24.3%) than those found in other studies evaluating CABG.68 Using Medicare data, Peterson et al9 found a

Conclusion

We found that cardiac surgery can be performed in the elderly with good hospital and late functional results, but at higher hospital costs than those for younger patients.

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