Impact of comorbidities on elderly patients undergoing open heart surgery

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J Cardiovascular Med (Hagerstown). 2022 Jan 10. doi: 10.2459/JCM.0000000000001296. Online ahead of print.

ABSTRACT

BACKGROUND: The number of elderly patients undergoing heart surgery is increasing. Age over 80 years has been identified as an important independent risk factor for short- and long-term survival. The current study aims to identify the impact of preoperative comorbidities on early and late outcomes in elderly patients undergoing cardiac surgery.

Methods: Baseline characteristics, procedures, and postoperative complications of all patients undergoing cardiac surgery at our institution are collected. The current analysis focuses on patients who were at least 80 years old at the time of the intervention and treated from January 2010 to December 2019.

RESULTS: In-hospital mortality was 6.3%. Redo the procedure [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.13-5.48], chronic obstructive pulmonary disease (COPD) (OR 2.99, 95% CI 1.75-5.12) and peripheral arterial disease (PAD) (OR 2.23, 95% CI 1.30-3, 81) were independent baseline predictors of outcome in multivariate analysis. Prolonged cardiopulmonary bypass time, need for transfusion, and prolonged intubation time strongly and independently predicted in-hospital mortality. During a mean follow-up of 3.6 years, 34.3% of patients died and were hospitalized unplanned (HR 1.33, 95% CI 1.05-1.67), NYHA class III- IV (HR 1.35, 95% CI 1.12-1.64), diabetes (HR 1.27, 95% CI 1.01-1.59), COPD (HR 1.60, 95% 1.25-2.04) and MAP (HR 1.32, 95% CI 1.03-1.71) were independent predictors of all-cause death.

CONCLUSION: Cardiac surgery is feasible in octogenarians, with an acceptable risk of mortality. Chronological age itself should not be the primary determinant of choice when referring patients for cardiac surgery. Comorbidities such as COPD, PAD, and diabetes should be considered for risk stratification.

PMID:35013050 | DOI:10.2459/JCM.0000000000001296