Predictors of Postoperative Complications in Octogenarians Undergoing Cardiac Surgery[*]

Abstract

Objective: Aim of the study was to clarify the impact of different pre- and perioperative conditions on outcome in octogenarians undergoing cardiac surgery. Methods: We retrospectively analyzed preoperative risk factors and intraoperative adverse events and studied in-hospital morbidity and mortality in 646 patients ≥ 80 years of age (82.5 ± 3.5 years) and in 6081 younger patients (70.3 ± 3.4 years) who underwent cardiac surgery between 1/2001 and 12/2006. Results: Preoperatively, octogenarians suffered significantly more from arterial hypertension, renal failure, previous neurological problems, unstable angina and NYHA class IV than younger subjects. The incidence of combined valve and coronary procedures and of urgent operations was also significantly higher in patients ≥ 80 years (27.7 % vs. 18.2 %, p < 0.05, and 7.3 % vs. 4.2 %, p < 0.05, respectively). In-hospital mortality was higher (7.4 % vs. 3.7 %, p < 0.05), and average ICU and total in-hospital stay was longer in the older age group. Postoperative complications occurred in 15 % of patients ≥ 80 years compared to 7.6 % of patients ≤ 79 years (p < 0.05). NYHA class IV, female sex and preoperative renal failure correlated with perioperative morbidity. Multivariate analysis could identify urgent procedures, redo surgery, mitral valve surgery and prolonged cross-clamping times as predictors of mortality. Conclusions: Cardiac surgery in octogenarians can be performed with an acceptable risk but an increased mortality and morbidity compared to younger patients. High-risk octogenarians, who require intensive perioperative management, should be identified to reduce the incidence of postoperative complications.

predictors - octogenarians - cardiac surgery - complications

Reference

• 1 Engoren M, Arslanian-Engoren C, Steckel D, Neihardt J, Fenn-Buderer N. Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery.  Chest. 2002;  122 1309-1315
• 2 Bahar I, Akgul A, Demirbag A E et al. Open heart surgery in patients with end-stage renal failure: fifteen-year experience.  J Card Surg. 2009;  24 24-29
• 3 Schmidtler F W, Tischler I, Lieber M et al. Cardiac surgery for octogenarians–a suitable procedure? Twelve-year operative and post-hospital mortality in 641 patients over 80 years of age.  Thorac Cardiovasc Surg. 2008;  56 14-19
• 4 Stoica S C, Cafferty F, Kitcat J et al. Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral.  Heart. 2006;  92 503-506
• 5 Suojaranta-Ylinen R T, Kuitunen A H, Kukkonen S I, Vento A E, Salminen U S. Risk evaluation of cardiac surgery in octogenarians.  J Cardiothorac Vasc Anesth. 2006;  20 526-530
• 6 Zingone B, Gatti G, Rauber E et al. Early and late outcomes of cardiac surgery in octogenarians.  Ann Thorac Surg. 2009;  87 71-78
• 7 Gerrah R, Izhar U, Elami A, Milgalter E, Rudis E, Merin G. Cardiac surgery in octogenarians – a better prognosis in coronary artery disease.  Isr Med Assoc J. 2003;  5 713-716
• 8 Gulbins H, Malkoc A, Ennker J. Combined cardiac surgical procedures in octogenarians: operative outcome.  Clin Res Cardiol. 2008;  97 176-180
• 9 Chertow G M, Levy E M, Hammermeister K E, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery.  Am J Med. 1998;  104 343-348
• 10 Stoica S C, Kalavrouziotis D, Martin B J et al. Long-term results of heart operations performed by surgeons-in-training.  Circulation. 2008;  118 S1-S6
• 11 Ender J, Borger M A, Scholz M et al. Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept.  Anesthesiology. 2008;  109 61-66

1 The results of this paper were presented in part during the 36^th annual meeting of the German Society of Thoracic- and Cardiovascular Surgery, February 11–14, 2007 in Hamburg, Germany.