Bardakci Hasmet, Cheema Faisal H, Topkara Veli K, Dang Nicholas C, Martens Timothy P, Mercando Michelle L, Forster Catherine S, Benson Ariel A, George Isaac, Russo Mark J, Oz Mehmet C, Esrig Barry C
Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University-New York Presbyterian Hospital, New York, New York 10032, USA.
Ann Thorac Surg. 2007 Feb;83(2):483-9. doi: 10.1016/j.athoracsur.2006.09.047.
The incidence of coronary artery bypass graft surgery (CABG) performed in elderly patients has been increasing over recent years. We sought to evaluate clinical outcomes of octogenarians undergoing CABG using an audited state-wide mandatory database.
New York State Department of Health's Cardiac Reporting System was analyzed from 1998 to 2002. In all, 88,154 patients undergoing isolated CABG were identified. Patients were divided into four age groups: less than 50 years (group 1, n = 6,527), 50 to 64 years (group 2, n = 30,088), 65 to 79 years (group 3, n = 43,369), and 80 years and above (group 4, n = 8,170).
Of all patients, 9.3% were octogenarians. In addition to marginally worse coronary artery disease, octogenarians generally manifested a higher incidence of preoperative risk factors such as cerebrovascular disease, peripheral vascular disease, and congestive heart failure compared with younger patients at baseline. Both length of hospital stay and in-hospital mortality rate were significantly higher among octogenarians. The incidence of postoperative complications was higher among octogenarians. Multivariate analysis demonstrated renal failure requiring dialysis (odds ratio [OR] = 4.4), myocardial infarction within 6 hours before surgery (OR = 3.6), chronic obstructive pulmonary disease (OR = 1.7), congestive heart failure at admission (OR = 1.7), emergent operation (OR = 1.6), Canadian Cardiovascular Society functional class IV (OR = 1.5), hypertension (OR = 1.4), and low ejection fraction (OR = 0.98) to be significant independent predictors of in-hospital mortality of octogenarians. Discharge to home rates were significantly lower for octogenarians.
Although early outcomes in octogenarians are acceptable, these factors alone are not sufficient to reflect overall success of CABG in these patients, given the strikingly lower discharge to home rates. Attention to full functional recovery in octogenarians is essential.
近年来，老年患者接受冠状动脉旁路移植术（CABG）的发生率一直在上升。我们试图利用一个经过审核的全州强制性数据库来评估八旬老人接受CABG的临床结果。
对纽约州卫生部的心脏报告系统进行了1998年至2002年的分析。总共识别出88154例接受单纯CABG的患者。患者被分为四个年龄组：小于50岁（第1组，n = 6527），50至64岁（第2组，n = 30088），65至79岁（第3组，n = 43369），以及80岁及以上（第4组，n = 8170）。
在所有患者中，9.3%为八旬老人。除了冠状动脉疾病略差外，与基线时的年轻患者相比，八旬老人术前危险因素如脑血管疾病、外周血管疾病和充血性心力衰竭的发生率普遍较高。八旬老人的住院时间和住院死亡率均显著更高。八旬老人术后并发症的发生率更高。多因素分析显示，需要透析的肾衰竭（比值比[OR] = 4.4）、手术前6小时内的心肌梗死（OR = 3.6）、慢性阻塞性肺疾病（OR = 1.7）、入院时的充血性心力衰竭（OR = 1.7）、急诊手术（OR = 1.6）、加拿大心血管学会功能分级IV级（OR = 1.5）、高血压（OR = 1.4）和低射血分数（OR = 0.98）是八旬老人住院死亡率的显著独立预测因素。八旬老人出院回家的比例显著更低。
尽管八旬老人的早期结果是可以接受的，但考虑到出院回家率显著更低，仅这些因素不足以反映CABG在这些患者中的总体成功率。关注八旬老人的完全功能恢复至关重要。
