reflection objectives: To evaluate cost.

reflection objectives: To evaluate cost, issue and functional status of octogenarians and septuagenarians after cardiac surgery

Design: Observational case bridle study. Retrospective analysis of hospital charge and outcome. Prospective analysis of functional status at 1 to 2 years.

Patients: common hundred three consecutive octogenarians and 103 randomly rareed 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 [les than or equal to] 0001) and to have had preoperative afflictions (p [less than or equal to] 005) however were less likely to have diabetes mellitus (p [les than or equal to] 0001) They were les likely to have undergone mitral valve surgery (p [les than or equal to] 001) on the other hand were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p [les than or equal to] 0001) The hospital mortality rate was 6% in the younger form into groups and 9% in the older arrange (odds ratio, 1.5; 95% confidence interval [CI], 05 to 45; p > 005) In patients undergoing isolated CABG, the mortality rate was 14% in the septuagenarians and 82% in the octogenarians (odd ratio, 62; 95% CI, 07 to 527; p = 012) Despite similar ICU, postoperative, and total details of stay, the median hospital direct variable costliness was 35% higher for the octogenarians. At late follow-up octogenarians had lower flats of physical functioning and general health still otherwise had levels of function that were similar to those of septuagenarians.

Conclusion: Cardiac surgery can be performed in the somewhat advanced in life with good hospital and late functional follows but at a higher hospital outlay than that for younger patients.

fundamental note words: cardiac surgery; coronary artery bypass grafting; direct variable cost; functional outcome; octogenarians; septuagenarians; survival

Abbreviations: CABG = coronary artery bypass graft; CI = confidence interval; CVA = cerebrovascular accident; CVICU = cardiovascular ICU; ECF = augmented care facility; RR = relative risk; SF-36 = 36-item short form; TCU = transitional care unit

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The somewhat advanced in life population is the fastest growing part of the US population, with an estimated 10 million living bodys aged [greater than or equal to] 80 years. Other westernized countries, including Japan, also have large and increasing somewhat advanced in life segments of their populations. Forty percent of these somewhat old persons have symptomatic cardiac disease. (12) Surgery a well-accepted means of increasing survival and improving quality of life in patients < 70 years of age, is becoming more habitual in septuagenarians and even octogenarians. However, perceptions on elderly patients, their families, and their physicians that they may have lower functional make an exception of and more comorbidities than younger patients, which are more likely to lead to complications or death, may make cardiologists and cardiac surgeon hesitant to proffer elderly patients life-saving or symptom-resolving cardiac surgery besides few studies exist to point out to the benefits, risks, and preciousnesss of cardiac surgery in octogenarians. Previous studies (3-6) have had small populations, are from the 1980 (improvements in perioperative techniques and care may make these proceeds obsolete), or have not evaluated functional results and costs in the same population. Therefore, the project of this study was duplicate as follows: (1) to determine hospital issues and costs; and (2) to measure functional results at 1 to 2 years in octogenarians compared to septuagenarians following cardiac surgery

MATERIALS AND METHODS

This consideration was approved by the institutional review board of a university-affiliated, tertiary care medical center The hospital's computerized medical information plan 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 ancient (cases) and an equal number of randomly rareed patients who were 70 to 79 years olden (control subjects) from the same time period had their charts reviewed through a single examiner. Because we wanted to papal court whether premorbid conditions varied between the sum of two units groups, we used randomly fix uponed control subjects rather than matching have charge of subjects for any particular characteristic. Charts were reviewed for the following: patient sex; marital status (ie, married, widowed, divorced, or single); comorbidities (ie, hypertension, hit cerebrovascular accident [CVA], myocardial infarction, diabetes mellitus, and COPD); use of antidepressant, antipsychotic, or anxiolytic medications (ie, CN put drugs into use); year of surgery (1998 or 1999); whether cardiac catheterization was performed during the same hospital admission as was the cardiac surgery; adumbration of cardiac surgery (ie, coronary artery bypass grafts [CABGs], aortic valve repair or replacement, mitral valve repair or replacement, carotid artery endarterectomy performed simultaneously with the cardiac surgery or other surgery similar as ascending aortic aneurysmectomy, left ventricular aneurysmectomy, tricuspid valve repair, and femoral artery aneurysmectomy, performed simultaneously with the primary cardiac surgery; use of cardiopulmonary bypass; transfusion; re-exploration for bleeding; the exhibition of a new focal central neurologic adventure (ie, CVA); the development of a of the present day global neurologic deficit not related to anesthesia or medicines that lasted > 24 h (encephalopathy); preoperative and peak postoperative serum creatinine levels; the unfolding of renal dysfunction (defined as a creatinine horizontal of [greater than or equal to] 20 mg/dL if the preoperative creatinine flat was normal, or a rise in the creatinine of the same height of [greater than or equal to] 10 mg/dL if the preoperative creatinine even was [greater than or equal to] 15 mg/dL); hemodialysis; defered mechanical ventilation (defined as a requirement for mechanical ventilation beyond 7 AM the day after surgery; atrial fibrillation; hospital outcome; and discharge to hearthstone extended care facility (ECF), transitional care unit (TCU) rehabilitation hospital, or other location.

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