RAPID RECOVERY OF OCTOGENARIANS FOLLOWING CORONARY-ARTERY BYPASS-GRAFTING

Background: Rapid recovery protocols for coronary artery bypass grafti ng (CABG) have resulted in major decreases in postoperative hospital l ength of stay (LOS) when applied to younger patients undergoing electi ve procedures. However, the effectiveness of rapid recovery protocols when applied to octogenarians has not been thoroughly studied. Methods : Thirty-seven consecutive octogenarians underwent isolated CABG utili zing cardiopulmonary bypass (CPB). A protocol emphasizing preoperative placement of the intra-aortic balloon pump, reduced CPB time, early e xtubation, perioperative steroids, thyroid hormone, and aggressive pos toperative diuresis was used. Results: The 30-day operative mortality for the entire series was 5.4%. Twenty-five patients (71%, group I) we re discharged in <10 days postoperatively (average LOS of 6.3+/-1.6 da ys), while ten patients (29%, group II) were discharged at 10 or more days postoperatively (average LOS of 20.3+/-8.0, p < 0.001). Patients in group II were found to have a higher incidence of obesity (50% vs 4 %, p < 0.01), symptomatic peripheral vascular disease (60% vs 8%, p < 0.01), and preoperative ambulatory difficulties (50% vs 0%, p < 0.01). The incidence of complications was 31% for the entire series, with no differences between the groups. Conclusion: Octogenarians performed w ell under a rapid recovery protocol, with 71% being discharged in < 10 days postoperatively, while patients with obesity, symptomatic periph eral vascular disease, and ambulatory difficulties rehabilitated more slowly.