Introduction: The adult cardiac surgery population is becoming increasingly aged. Advanced age has been shown to correlate with co-morbidity, increased hospital stay and adverse outcome . We have analysed our recent database in order to establish relative risk of surgery in the elderly, and to identify areas amenable to improvement.
Method: We compared 411 patients aged over 75 years (Group 1) with 1466 patients aged 60-75yrs (Group 2), undergoing cardiac surgery over 30 months. We recorded the minimum dataset for the Society of Cardiothoracic Surgeons of Britain and Ireland. All surgical procedures were included.
Data from the 2 groups were compared using Pearson chi-squared statistic for categorical and Mann-Whitney U test for continuous variables. The association between mortality and each variable was calculated using logistic regression. Multivariate modelling was used to identify the role of age as a risk factor for in-hospital mortality. Variables were added to the model in a step-wise sequence. Variables remaining in the model were tested consecutively for evidence of interaction with age. The analysis was carried out using STATA Vs 6.0.
Results: Group 1 patients had a significantly greater incidence of the following (P < 0.001); female gender, low BMI, severe cardiac symptoms including angina, breathlessness, arrhythmia and previous smoking. There was no difference in the incidence of diabetes, hypertension, renal, respiratory, peripheral vascular and cerebrovascular disease. Simple and age-adjusted EuroSCORE and Parsonnet scores were significantly higher (P < 0.01) in Group 1. Group 1 patients had a higher incidence of aortic valve and combined CABG and valve surgery (P < 0.001), longer bypass and cross clamp times (P < 0.01) and a higher incidence of non-elective surgery (P < 0.001). In the univariate analysis, age >75 was associated with a higher in-hospital mortality risk (Group 1-11%; Group 2-5%; P < 0.001).
Discussion: We found that older patients had double the mortality risk of the younger patients. Older patients are more likely to suffer severe cardiovascular symptoms and more urgent operations. These independent predictors of adverse outcome may be amenable to better preoperative medication. Older patients undergo longer operations and more combined operations which also correlate with poor outcome. This may be altered by more rigorous perioperative decision making.
1 Mortasawi A, Arnrich B, Rosendahl U, et al. Is age an independent determinant of mortality in cardiac surgery as suggested by the EuroSCORE? BMC Surg