Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Cardiol. 2014 Feb;30(2):224-30. doi: 10.1016/j.cjca.2013.10.020. Epub 2013 Nov 6.
Advances in cardiac surgical care have allowed for successful surgery in high-risk elderly patients. Advances in percutaneous coronary intervention (PCI) techniques and expanded indications for PCI have resulted in a decrease in referrals for coronary artery bypass grafting (CABG). Our objective was to document changes in practice patterns and outcomes in a single tertiary cardiac surgery centre serving a large geographic area.
For all cardiac surgery cases performed from 2001-2010 we examined its use, patient clinical characteristics, and outcomes. Frailty was assessed using a measure we have previously demonstrated to be associated with adverse outcomes.
During the study period, annual case volume decreased by 13%. The number of isolated CABG cases declined, and valve surgery and other complex procedures increased. The proportion of patients aged ≥ 80 years rose from 7%-12%, and the proportion of frail patients increased from 4%-10%. Although unadjusted in-hospital mortality remained relatively unchanged, intensive care unit (ICU) stays and prolonged institutional care increased. Older age and frailty were associated with mortality, prolonged ICU stays, prolonged institutional care, and a composite of mortality and major morbidities.
Our findings showed a decline in CABG, an increase in more complex operations, and an increase in prolonged ICU stays and prolonged institutional care. The proportion of frail and elderly patients increased over time and these patient groups were at higher risk of adverse postoperative outcomes. Particular attention is required in the decision for surgery and perioperative management of these patients.
心脏外科学的进步使高危老年患者的手术取得成功。经皮冠状动脉介入治疗（PCI）技术的进步和 PCI 适应证的扩大导致冠状动脉旁路移植术（CABG）的转诊减少。我们的目的是记录在一个为广大地理区域服务的单一三级心脏手术中心的实践模式和结果的变化。
对于 2001-2010 年期间进行的所有心脏手术病例，我们检查了其使用情况、患者临床特征和结果。使用我们之前证明与不良结果相关的措施评估虚弱。
在研究期间，每年的病例量减少了 13%。单纯 CABG 病例数量减少，瓣膜手术和其他复杂手术增加。年龄≥80 岁的患者比例从 7%上升至 12%，虚弱患者的比例从 4%上升至 10%。尽管未经调整的住院死亡率保持相对不变，但重症监护病房（ICU）入住时间和长期机构护理增加。年龄较大和虚弱与死亡率、延长的 ICU 入住时间、延长的机构护理以及死亡率和主要合并症的复合因素相关。
我们的研究结果显示 CABG 减少、更复杂的手术增加以及 ICU 入住时间和长期机构护理延长。虚弱和老年患者的比例随时间增加，这些患者群体术后不良结果的风险更高。在这些患者的手术决策和围手术期管理中需要特别注意。
