Recent improvement in results of coronary bypass surgery in octogenarians

Background. Because of concerns regarding the cost-effectiveness of coronar y artery surgery in patients 80 years and older, a review of a large experi ence is appropriate. Methods. The records of 404 consecutive patients 80 Sears of age or older h aving isolated coronary bypass surgery (CABG) from 1985 through 1996 were r eviewed. Patients were divided equally into an early and later group. Hospi tal mortality, complications including major arrhythmias, wound infections and separations, re-explorations, peri-operative Q-wave myocardial infarcti ons, major organ dysfunction, stroke, time to extubation, post-operative ho spital (LOS) and intensive care unit (ICU) lengths of stay were compared. A logistic regression risk model was used to assess the relative contributio ns of improved technique versus more favorable patient selection. Results. Comparison of the two groups revealed the following: overall hospi tal mortality decreased from 12.9% to 5.4% (p = 0.003), more markedly so wi th elective procedures where hospital mortality decreased from 8.1% to 1.2% (p = 0.04). There were significant decreases in time to extubation (2.8 +/ - 9.3 days versus 1.2 +/- 2.8 days; p = 0.02), post-operative intensive car e unit stay (4.9 +/- 7.1 days versus 2.9 +/- 3.7 days; p = 0.0004), post-op erative complication rate (34.2% versus 22.8%; p = 0.03), and post-operativ e hospital length of stay (14.2 +/- 14.7 days versus 9.8 +/- 9.8 days; p = 0.0005). Post-operative stroke decreased from 7.4% to 5.9%. Mean estimated risk for the two groups was 8.2 +/- 10.2% versus 8.2 +/- 11.4%. Conclusion. Coronary surgery can be performed with acceptable risk in octog enarians. Results have improved over the past few years, This improvement i s probably not attributable to patient selection.