Deschka Heinz, Müller Dirk, Dell'Aquila Angelo, Matthäus Martin, Erler Stefan, Wimmer-Greinecker Gerhard
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Department of Cardiology, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
Geriatr Gerontol Int. 2016 Apr;16(4):416-23. doi: 10.1111/ggi.12484. Epub 2015 Mar 21.
The general assumption that non-elective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life (QOL) might lead to a non-justified exclusion of elderly patients from surgical treatment. The aim of the present study was to assess survival, functional outcome and quality of life of octogenarians undergoing non-elective cardiac surgery.
Between 2009 and 2011, 62 consecutive octogenarians (mean age 83.5 ± 3.5 years) underwent urgent (n = 33) or emergency (n = 29) cardiac surgery. In 69% of patients, coronary artery bypass grafting was carried out, and 24% of patients underwent coronary artery bypass grafting plus valve surgery. Preoperative risk, as well as the postoperative course, was analyzed. All discharged patients were contacted to gain information about survival, functional capacity and QOL using the Barthel Mobility Index and the Short Form 12 Health Survey questionnaire. Results were compared with age-adjusted population data.
In-hospital mortality was 32.3% overall, 9.3% in urgent cases and 56.7% in emergency cases. After a mean follow-up period of 447 ± 359 days, survival of the discharged patients was 93.1% (urgent) and 76.9% (emergency), respectively. QOL measures of the survivors were equivalent to those of the general elderly population. Functional capacity, calculated with Barthel Index, was high in both groups (86 ± 13 and 81 ± 21). A total of 92% of the patients were living at home.
Although non-elective cardiac surgery in the elderly is related to high in-hospital mortality, physical and psychological recovery of the survivors is encouraging. QOL equals that of the general elderly population, and good functional status offers a highly independent life. Therefore, age per se should not disqualify patients from urgent or emergency cardiac surgery.
一般认为，八旬老人的非选择性心脏手术与术后不良预后及生活质量（QOL）相关，这可能导致不合理地将老年患者排除在手术治疗之外。本研究的目的是评估接受非选择性心脏手术的八旬老人的生存率、功能结局和生活质量。
2009年至2011年期间，62例连续的八旬老人（平均年龄83.5±3.5岁）接受了急诊（n = 33）或紧急（n = 29）心脏手术。69%的患者进行了冠状动脉旁路移植术，24%的患者接受了冠状动脉旁路移植术加瓣膜手术。分析术前风险以及术后病程。通过电话联系所有出院患者，使用巴氏运动指数和简短健康调查问卷12来获取有关生存率、功能能力和生活质量的信息。将结果与年龄调整后的人群数据进行比较。
总体住院死亡率为32.3%，急诊病例为9.3%，紧急病例为56.7%。平均随访447±359天后，出院患者的生存率分别为93.1%（急诊）和76.9%（紧急）。幸存者的生活质量指标与一般老年人群相当。两组通过巴氏指数计算的功能能力均较高（86±13和81±21）。共有92%的患者在家中生活。
尽管老年患者的非选择性心脏手术与高住院死亡率相关，但幸存者的身体和心理恢复情况令人鼓舞。生活质量与一般老年人群相当，良好的功能状态使患者能够高度独立生活。因此，年龄本身不应成为患者接受急诊或紧急心脏手术的禁忌。
