孤立冠状动脉搭桥术后按年龄划分的寿命及入住养老院情况：一项全国性队列研究。
Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study.
作者信息
Thorsteinsson Kristinn, Andreasen Jan J, Mortensen Rikke N, Kragholm Kristian, Torp-Pedersen Christian, Gislason Gunnar, Køber Lars, Fonager Kirsten
机构信息
Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
出版信息
Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):792-8. doi: 10.1093/icvts/ivw045. Epub 2016 Mar 10.
OBJECTIVES
Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort.
METHODS
All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012.
RESULTS
A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients <60 years and 7.8% in patients ≥80 years). The mortality rate at 1 year was 2.2% among patients aged <60 and 14.1% among patients ≥80 years. At the 1-year follow-up, 4.2% of patients <60 years, 7.9% of patients 60-70 years, 14.4% of patients 70-74 years, 18.5% of patients 75-79 years and 29.1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (<60 years), and 1.4, 7.5 and 16.8% (≥80 years), respectively. Main predictors for living in a nursing home 1 year postoperatively were: age ≥80 years [hazard ratio (HR) 17.8, 95% confidence interval (CI) 7.4-42.8], female sex (HR 1.7, 95% CI 1.1-2.6), previous heart failure (HR 1.6, 95% CI 1.0-2.4), previous myocardial infarction (HR 2.0, 95% CI 1.3-3.2) and previous stroke (HR 3.3, 95% CI 2.1-4.9). Neither urgent nor emergency surgeries were significant predictors for living in a nursing home 1 year postoperatively.
CONCLUSIONS
The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk of nursing home admission was small and dependent on the patient's age, sex and preoperative comorbidities.
目的
关于80岁及以上患者在单纯冠状动脉旁路移植术（CABG）后入住养老院的数据稀缺。本研究的目的是在全国性CABG队列中，评估按年龄分层的患者寿命及随后入住养老院的情况。
方法
通过全国性登记系统识别出1996年至2012年在丹麦接受单纯CABG的所有患者。估计CABG后入住养老院的累积发生率。构建Cox回归模型以识别CABG后1年入住养老院的预测因素。采用Kaplan-Meier估计进行生存分析。在2008 - 2012年期间对家庭护理使用情况进行亚分析。
结果
共纳入38487例患者。中位年龄为65.4±9.5岁（1455例年龄大于80岁），80%为男性。30天死亡率为2.8%，随年龄增加（<60岁患者为1.2%，≥80岁患者为7.8%）。<60岁患者1年死亡率为2.2%，≥80岁患者为14.1%。在1年随访时，<60岁患者中有4.2%、60 - 70岁患者中有7.9%、70 - 74岁患者中有14.4%、75 - 79岁患者中有18.5%以及≥80岁患者中有29.1%接受了家庭护理。CABG后1年、5年和10年入住养老院的患者比例分别为0.1%、0.4%和1.0%（<60岁），以及1.4%、7.5%和16.8%（≥80岁）。术后1年入住养老院的主要预测因素为：年龄≥80岁[风险比（HR）17.8，95%置信区间（CI）7.4 - 42.8]、女性（HR 1.7，95% CI 1.1 - 2.6）、既往心力衰竭（HR 1.6，95% CI 1.0 - 2.4）、既往心肌梗死（HR 2.0，95% CI 1.3 - 3.2）和既往中风（HR 3.3，95% CI 2.1 - 4.9）。急诊手术和非急诊手术均不是术后1年入住养老院的显著预测因素。
结论
1996 - 2012年在丹麦接受CABG手术的所有患者，包括老年人，大多数在CABG后多年能够独立在家生活，无需家庭护理。入住养老院的风险较小，且取决于患者的年龄、性别和术前合并症。
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