Engoren Milo, Arslanian-Engoren Cynthia, Steckel Donna, Neihardt Julie, Fenn-Buderer Nancy
Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA.
Chest. 2002 Oct;122(4):1309-15. doi: 10.1378/chest.122.4.1309.
To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery.
Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years.
One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who underwent cardiac surgery.
A university-affiliated tertiary care center.
Compared to septuagenarians, octogenarians were more likely to be widowed (p < or = 0.001) and to have had preoperative strokes (p < or = 0.05) but were less likely to have diabetes mellitus (p < or = 0.001). They were less likely to have undergone mitral valve surgery (p < or = 0.01) but were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p < or = 0.001). The hospital mortality rate was 6% in the younger group and 9% in the older group (odds ratio, 1.5; 95% confidence interval [CI], 0.5 to 4.5; p > 0.05). In patients undergoing isolated CABG, the mortality rate was 1.4% in the septuagenarians and 8.2% in the octogenarians (odds ratio, 6.2; 95% CI, 0.7 to 52.7; p = 0.12). Despite similar ICU, postoperative, and total lengths of stay, the median hospital direct variable cost was 35% higher for the octogenarians. At late follow-up, octogenarians had lower levels of physical functioning and general health but otherwise had levels of function that were similar to those of septuagenarians.
Cardiac surgery can be performed in the elderly with good hospital and late functional results, but at a higher hospital cost than that for younger patients.
评估八旬和七旬老人心脏手术后的费用、结局及功能状态。
观察性病例对照研究。回顾性分析医院费用和结局。前瞻性分析1至2年时的功能状态。
103例连续接受心脏手术的八旬老人和103例随机选取的七旬老人。
一所大学附属的三级医疗中心。
与七旬老人相比，八旬老人更可能丧偶（p≤0.001）且术前有中风史（p≤0.05），但患糖尿病的可能性较小（p≤0.001）。他们接受二尖瓣手术的可能性较小（p≤0.01），但接受非体外循环冠状动脉搭桥手术的可能性较大（p≤0.001）。较年轻组的医院死亡率为6%，较年长组为9%（比值比，1.5；95%置信区间[CI]，0.5至4.5；p>0.05）。在接受单纯冠状动脉搭桥术的患者中，七旬老人的死亡率为1.4%，八旬老人为8.2%（比值比，6.2；95%CI，0.7至52.7；p = 0.12）。尽管重症监护病房、术后及总住院时长相似，但八旬老人的医院直接可变成本中位数高出35%。在晚期随访时，八旬老人的身体功能和总体健康水平较低，但其他功能水平与七旬老人相似。
老年患者可以接受心脏手术，医院结局和晚期功能结果良好，但医院费用高于年轻患者。
