Basaran Murat, Selimoglu Ozer, Ozcan Hamiyet, Ogus Halide, Kafali Eylul, Ozcelebi Cuneyt, Ogus Temucin Noyan
Cardiovascular Surgery Clinic, Goztepe Safak Hospital, Istanbul, Turkey.
Eur J Cardiothorac Surg. 2007 Jul;32(1):58-64. doi: 10.1016/j.ejcts.2007.03.030. Epub 2007 Apr 20.
Despite the refinements in surgical techniques and postoperative care, elderly women still have a higher prevalence of postoperative morbidity.
The outcomes of 112 elderly women (>80 years) who underwent an elective CABG procedure were compared with those of males operated during the same time interval (n, 164).
Median age of female and male patients were 82 and 83 years, respectively. Mean number of grafts did not differ significantly (3.7+/-0.8 vs 3.9+/-0.3, p=0.4) between groups. Overall early operative mortality rate was 8.6% (24 of 276 patients); 8.9% (10 of 112 patients) for female and 8.5% (14 of 164 patients) for male patients (p=0.1). Postoperative complications including prolonged ventilation time (13.4% in females vs 8.5% in male, p<0.01), atrial fibrillation (40% in females vs 33% in males, p=0.01), sternal reclosure (8% in females vs 4.2% in males, p=0.01), pneumonia (5.3% in females vs 3% in males, p=0.03), leg wound infection (11.7% in females vs 2.4% in males, p<0.001), renal dysfunction (10.7% in females vs 7.3% in young patients, p=0.02) have been found to be significantly higher in elderly women. Mean intensive care unit (3.2+/-1.1 days in females vs 1.6+/-0.4 in males, p=0.03), and hospital stays (13.6+/-2.1 days in females vs 9.1+/-1.2 in males, p=0.02) were also longer in female patients. Five-year survivals including all deaths for female and male patients were 57% and 62%, respectively.
In elderly women, revascularization procedures can be done with acceptable mortality rates; but these patients are still associated with a higher prevalence of postoperative morbidity when compared with the male counterparts. Therefore, these patients have to be very carefully evaluated preoperatively and their postoperative care should be more comprehensive to reduce the incidence of postoperative complications.
尽管手术技术和术后护理有所改进，但老年女性术后发病率仍然较高。
将112例接受择期冠状动脉搭桥术（CABG）的老年女性（>80岁）的手术结果与同期接受手术的男性患者（n = 164）的结果进行比较。
女性和男性患者的中位年龄分别为82岁和83岁。两组之间平均移植血管数量无显著差异（3.7±0.8对3.9±0.3，p = 0.4）。总体早期手术死亡率为8.6%（276例患者中的24例）；女性为8.9%（112例患者中的10例），男性为8.5%（164例患者中的14例）（p = 0.1）。术后并发症包括通气时间延长（女性为13.4%，男性为8.5%，p<0.01）、心房颤动（女性为40%，男性为33%，p = 0.01）、胸骨重新闭合（女性为8%，男性为4.2%，p = 0.01）、肺炎（女性为5.3%，男性为3%，p = 0.03）、腿部伤口感染（女性为11.7%，男性为2.4%，p<0.001）、肾功能不全（女性为10.7%，男性为7.3%，p = 0.02），老年女性的这些并发症发生率显著更高。女性患者的平均重症监护病房住院时间（3.2±1.1天对男性的1.6±0.4天，p = 0.03）和住院时间（女性为13.6±2.1天对男性的9.1±1.2天，p = 0.02）也更长。包括所有死亡病例在内的女性和男性患者的五年生存率分别为57%和62%。
对于老年女性，血管重建手术可以在可接受的死亡率下进行；但与男性相比，这些患者术后发病率仍然较高。因此，术前必须对这些患者进行非常仔细的评估，并且术后护理应更加全面，以降低术后并发症的发生率。
