Toor Iqbal, Bakhai Ameet, Keogh Bruce, Curtis Miles, Yap John
The Heart Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
Interact Cardiovasc Thorac Surg. 2009 Nov;9(5):827-31. doi: 10.1510/icvts.2009.210872. Epub 2009 Aug 27.
We examined whether complication rates and resource utilization among elderly patients undergoing coronary artery bypass grafting (CABG) differed from their younger counterparts. A retrospective review of prospectively collected data was conducted of 2936 patients undergoing first-time isolated CABG. Demographic and baseline clinical characteristics were collected, and patients grouped according to age into those <75 years (n=2424, younger) and >or=75 years (n=512, older). Major postoperative complications were recorded and data collected on indicators of resource utilization, which included intensive care unit (ICU) length of stay (LOS), postoperative LOS and total hospital LOS. In comparison with younger patients, older patients were more likely to be female (26.6% vs. 18.1%, P<0.0001) and require an urgent procedure (46.4% vs. 33.3%, P<0.0001). Postoperative complications were significantly higher in elderly patients (43.7% vs. 23.0%; odds ratio (OR)=2.5, 95% confidence interval (CI) [2.0-3.1]; P<0.0001). Older patients incurred longer intensive care stays (2 days interquartile range (IQR) [1-3] vs. 1 day IQR [1-2]; P<0.0001) and a longer postoperative stay (8 days IQR [6-11] vs. 6 days IQR [5-8]; P<0.0001). Multivariate logistic regression analysis showed age >or=75 years was an independent predictor of postoperative LOS (OR=1.23, 95% CI [0.49-1.96]; P=0.001). Older patients aged >or=75 years undergoing CABG had significantly higher rates of postoperative complications and greater resource utilization than their younger counterparts.
我们研究了接受冠状动脉搭桥术（CABG）的老年患者的并发症发生率和资源利用情况是否与其年轻患者不同。对2936例接受首次单纯CABG的患者进行了前瞻性收集数据的回顾性分析。收集了人口统计学和基线临床特征，并根据年龄将患者分为<75岁（n = 2424，年轻组）和≥75岁（n = 512，老年组）。记录主要术后并发症，并收集资源利用指标数据，包括重症监护病房（ICU）住院时间（LOS）、术后LOS和总住院LOS。与年轻患者相比，老年患者女性比例更高（26.6%对18.1%，P<0.0001），且更需要急诊手术（46.4%对33.3%，P<0.0001）。老年患者术后并发症明显更高（43.7%对23.0%；优势比（OR）=2.5，95%置信区间（CI）[2.0 - 3.1]；P<0.0001）。老年患者的重症监护停留时间更长（四分位数间距（IQR）为2天[1 - 3]对1天IQR[1 - 2]；P<0.0001），术后停留时间也更长（IQR为8天[6 - 11]对6天IQR[5 - 8]；P<0.0001）。多因素逻辑回归分析显示年龄≥75岁是术后LOS的独立预测因素（OR = 1.23，95%CI[0.49 - 1.96]；P = 0.001）。接受CABG的≥75岁老年患者术后并发症发生率明显高于年轻患者，资源利用也更多。
