Al-Alao Bassel S, Parissis Haralabos, McGovern Eilis, Tolan Michael, Young Vincent K
Department of Cardiothoracic Surgery, St James's Hospital, Dublin, Ireland.
Gen Thorac Cardiovasc Surg. 2012 Apr;60(4):217-24. doi: 10.1007/s11748-011-0875-0. Epub 2012 Mar 28.
We looked at the complications and hospital resources of an elderly population undergoing first-time isolated coronary artery bypass graft surgery (CABG) in comparison to a younger counterpart for a propensity matched cohort.
A retrospective analysis of prospectively collected data was conducted on 2804 CABG patients. Two age groups, >75 years and ≤75 years, were generated. Potential differences in demographic, baseline, preoperative, and intraoperative characteristics were investigated. A propensity score based on these differences was calculated and used to create a matched set of patients. Major postoperative complications were recorded, and data on indicators of resource utilization were collected.
In all, 311 (11.1%) patients were identified as >75 years of age. The observed complication rate was significantly higher in overall, pulmonary, cardiac, renal, gastrointestinal (GI), neurological, infective, and mortality categories (P < 0.0001). Observed hospital resource utilization was significant in the elderly group in terms of initial stay in the intensive care unit (ICU) and ICU readmission (P < 0.05) and in all preoperative, postoperative, cardiac surgery, and total hospital stays (P < 0.001). However, after propensity matching to 311 patients ≤75 years, the overall postoperative complication rate maintained its significance (P < 0.0001), in addition to atrial fibrillation and neurological, renal, and GI complications (P < 0.05). Elderly patients required longer duration of ventilation postoperatively and longer postoperative stay, cardiac surgery stay, and total hospital stay; and they maintained a higher surgical mortality rate (6.1% vs. 2.6%) (P < 0.05).
Elderly patients undergoing CABG had significantly higher rates of postoperative complications. Their prolonged hospital stay and consequently higher resources utilization need to be adequately highlighted to heath care officials and appropriately addressed.
我们观察了首次接受单纯冠状动脉旁路移植术（CABG）的老年人群与年轻人群相比的并发症情况及医院资源使用情况，以构建一个倾向匹配队列。
对2804例CABG患者前瞻性收集的数据进行回顾性分析。划分出两个年龄组，即年龄大于75岁和年龄小于等于75岁。研究人口统计学、基线、术前及术中特征的潜在差异。基于这些差异计算倾向得分，并用于创建匹配的患者组。记录术后主要并发症，并收集资源利用指标数据。
总共311例（11.1%）患者年龄大于75岁。总体、肺部、心脏、肾脏、胃肠道（GI）、神经、感染及死亡率方面观察到的并发症发生率显著更高（P<0.0001）。就重症监护病房（ICU）初始住院时间和ICU再次入院情况而言，老年组观察到的医院资源利用情况有显著差异（P<0.05），在所有术前、术后、心脏手术及总住院时间方面也有显著差异（P<0.001）。然而，在与311例年龄小于等于75岁的患者进行倾向匹配后，除房颤、神经、肾脏及胃肠道并发症外，总体术后并发症发生率仍具有显著性（P<0.0001）（P<0.05）。老年患者术后需要更长的通气时间以及更长的术后住院时间、心脏手术住院时间和总住院时间；且他们维持着更高的手术死亡率（6.1%对2.6%）（P<0.05）。
接受CABG的老年患者术后并发症发生率显著更高。他们延长的住院时间以及因此更高的资源利用情况需要向医疗保健官员充分强调并妥善处理。
