Deschka Heinz, Schreier Romy, El-Ayoubi Lemir, Erler Stefan, Müller Dirk, Alken Aiman, Wimmer-Greinecker Gerhard
Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen, Germany.
Interact Cardiovasc Thorac Surg. 2013 Sep;17(3):501-6. doi: 10.1093/icvts/ivt229. Epub 2013 May 24.
In accordance with the rising prevalence of octogenarians undergoing cardiac surgery, these patients utilize an increasing portion of intensive care unit (ICU) capacities, provoking economic and ethical concerns. In this study, we evaluated the outcomes and costs generated by the prolonged postoperative ICU treatment of octogenarians.
Between July 2009 and August 2010, 109 of 1063 patients required ICU treatment of at least 5 days after cardiac surgery. Patients were retrospectively assigned to either Group A (age <80, n = 86) or Group B (age ≥80, n = 23). Operative risk, mortality, length and costs of ICU treatment were analysed and compared. After 1 year, survival, quality of life (QOL) and functional status were assessed.
Hospital mortality was 31.4% in Group A and 56.5% in Group B. Survivals of discharged patients after 1 year were 83% (Group A) and 80% (Group B), respectively. Log EuroSCORE I of octogenarians was significantly higher (30 ± 17 vs 20 ± 16, P < 0.001). No significant differences (Group A vs Group B) were found between the groups concerning length of ICU treatment (20 ± 21 vs 16 ± 14 days, P = 0.577) or costs (27 205 ± 29 316€ vs 21 821 ± 16 259€, P = 0.812). Functional capacity, calculated by using Barthel index, was high (Group A: 87 ± 22 and Group B: 67 ± 31, P = 0.108) and did not differ significantly between groups. QOL, measured with the short form-12 health survey, did not differ significantly between groups (physical health summary score: P = 0.27; mental health score: P = 0.885) and was comparable with values of the age-adjusted general population.
Presented data propose that advanced age is correlated with a higher mortality, but not with prolonged ICU treatment or higher costs after cardiac surgery. Considering the encouraging functional status and QOL of the survivors, the financial burden caused by octogenarians is justified.
随着接受心脏手术的八旬老人患病率上升，这些患者占用了重症监护病房（ICU）越来越多的资源，引发了经济和伦理方面的担忧。在本研究中，我们评估了八旬老人术后长时间ICU治疗的结果和成本。
2009年7月至2010年8月期间，1063例患者中有109例在心脏手术后需要至少5天的ICU治疗。患者被回顾性分为A组（年龄<80岁，n = 86）或B组（年龄≥80岁，n = 23）。分析并比较手术风险、死亡率、ICU治疗时长和成本。1年后，评估生存率、生活质量（QOL）和功能状态。
A组医院死亡率为31.4%，B组为56.5%。出院患者1年后的生存率分别为83%（A组）和80%（B组）。八旬老人的欧洲心脏手术风险评估系统I（EuroSCORE I）显著更高（30±17 vs 20±16，P<0.001）。两组之间在ICU治疗时长（20±21天 vs 16±14天，P = 0.577）或成本（27205±29316欧元 vs 21821±16259欧元，P = 0.812）方面未发现显著差异。使用巴氏指数计算的功能能力较高（A组：87±22，B组：67±31，P = 0.108），两组之间无显著差异。用简短健康调查问卷12项（short form-12 health survey）测量的QOL在两组之间无显著差异（身体健康总结评分：P = 0.27；心理健康评分：P = 0.885），且与年龄调整后的普通人群值相当。
现有数据表明，高龄与较高的死亡率相关，但与心脏手术后延长的ICU治疗或更高的成本无关。考虑到幸存者令人鼓舞的功能状态和QOL，八旬老人造成的经济负担是合理的。
