RISKS OF CARDIAC OPERATIONS FOR ELDERLY PATIENTS - REDUCTION OF THE AGE FACTOR

Background. Age has been considered an important risk factor for cardi ac operations. Recent refinements have been designed to reduce cardiac , neurologic, and renal complications. Methods. Analysis of cardiac su rgical outcomes including mortality, length of stay, complications, an d costs were undertaken for a consecutive series of 285 patients 70 ye ars old and older and 568 patients younger than 70 years who underwent operation during 1991 through 1995. Management included antegrade and retrograde cold and warm blood cardioplegia, epicardial echocardiogra phy, retrosternal dissection for reoperations, maintenance of ''normal '' arterial pressure, and measures to avoid renal dysfunction. Parsonn et risk stratification and multiple regression were used to account fo r risk factors. Results. The 30-day mortality rate for elderly patient s was 1.8% (5/285) and 1.8% (10/568) for patients less than 70 years o ld (p = not significant). The hospital mortality rate for the elderly patients was 3.2% (9/285) versus 2.5% (14/568) for the younger group ( p = not significant). The frequencies of complications were not differ ent. Over the 5-year period, length of stay decreased from 12.5 +/- 1. 5 days to 8.9 +/- 0.9 days for patients 70 years old and older and fro m 11.5 +/- 0.1 to 6.4 +/- 0.3 days for patients less than 70 years old . Hospital charges for the elderly group were 13% higher. Conclusions. Modern cardiac surgical techniques and clinical practices have reduce d the importance of the age factor. (C) 1997 by The Society of Thoraci c Surgeons.