八旬老人接受冠状动脉旁路移植术的结果。
Outcomes in octogenarians undergoing coronary artery bypass grafting.
作者信息
Baskett Roger, Buth Karen, Ghali William, Norris Colleen, Maas Tony, Maitland Andrew, Ross David, Forgie Rand, Hirsch Gregory
机构信息
Department of Surgery, Dalhousie University, Halifax, NS.
出版信息
CMAJ. 2005 Apr 26;172(9):1183-6. doi: 10.1503/cmaj.1041342.
BACKGROUND
Although octogenarians are being referred for coronary artery bypass grafting (CABG) with increasing frequency, contemporary outcomes have not been well described. We examined data from 4 Canadian centres to determine outcomes of CABG in this age group.
METHODS
Data for the years 1996 to 2001 were examined in a comparison of octogenarians with patients less than 80 years of age. Logistic regression analysis was used to adjust for preoperative factors and to generate adjusted rates of mortality and postoperative stroke.
RESULTS
A total of 15,070 consecutive patients underwent isolated CABG during the study period. Overall, 725 (4.8%) were 80 years of age or older, the proportion increasing from 3.8% in 1996 to 6.2% in 2001 (p for linear trend = 0.03). The crude rate of death was higher among the octogenarians (9.2% v. 3.8%; p < 0.001), as was the rate of stroke (4.7% v. 1.6%, p < 0.001). The octogenarians had a significantly greater burden of comorbid conditions and more urgent presentation at surgery. After adjustment, the octogenarians remained at greater risk for in-hospital death (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.95-3.57) and stroke (OR 3.25, 95% CI 2.15-4.93). Mortality declined over time for both age groups (p for linear trend < 0.001 for both groups), but the incidence of postoperative stroke did not change (p for linear trend = 0.61 [age < 80 years] and 0.08 [age > or = 80 years]). Octogenarians who underwent elective surgery had crude and adjusted rates of death (OR 1.31, 95% CI 0.60-2.90) and stroke (OR 1.59, 95% CI 0.57-4.44) that were higher than but not significantly different from those for non-octogenarians who underwent elective surgery.
INTERPRETATION
In this study, rates of death and stroke were higher among octogenarians, although the adjusted differences in mortality over time were decreasing. The rate of adverse outcomes in association with elective surgery was similar for older and younger patients.
背景
尽管越来越多的八旬老人被转诊接受冠状动脉旁路移植术（CABG），但目前尚未对当代的手术结果进行充分描述。我们分析了来自加拿大4个中心的数据，以确定该年龄组患者接受CABG的手术结果。
方法
我们比较了1996年至2001年间八旬老人与年龄小于80岁患者的数据。采用逻辑回归分析来校正术前因素，并得出校正后的死亡率和术后卒中发生率。
结果
在研究期间，共有15,070例患者连续接受了单纯CABG手术。总体而言，725例（4.8%）患者年龄在80岁及以上，这一比例从1996年的3.8%上升至2001年的6.2%（线性趋势p值=0.03）。八旬老人的粗死亡率更高（9.2%对3.8%；p<0.001），卒中发生率也更高（4.7%对1.6%，p<0.001）。八旬老人合并症负担更重，手术时病情更紧急。校正后，八旬老人住院死亡风险（比值比[OR]2.64，95%置信区间[CI]1.95-3.57）和卒中风险（OR 3.25，95%CI 2.15-4.93）仍然更高。两个年龄组的死亡率均随时间下降（两组线性趋势p值均<0.001），但术后卒中发生率没有变化（年龄<80岁组线性趋势p值=0.61，年龄≥80岁组p值=0.08）。接受择期手术的八旬老人的粗死亡率和校正后死亡率（OR 1.31，95%CI 0.60-2.90）以及卒中发生率（OR 1.59，95%CI 0.57-4.44）高于接受择期手术的非八旬老人，但差异无统计学意义。
解读
在本研究中，八旬老人的死亡和卒中发生率更高，尽管校正后的死亡率随时间的差异在减小。老年和年轻患者择期手术的不良结局发生率相似。
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