Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark; The Danish Heart Foundation, Denmark.
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark; The Danish Heart Foundation, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
Eur J Intern Med. 2016 Nov;35:55-59. doi: 10.1016/j.ejim.2016.05.028. Epub 2016 Jun 13.
Advanced age increases the risk of perioperative cardiovascular complications and may pose reluctance to subject elderly patients to surgery. We examined the impact of high age on perioperative major adverse cardiovascular events (MACE) and mortality in a nationwide cohort of patients undergoing elective surgery.
All Danish patients aged ≥20years undergoing non-cardiac, elective surgery in 2005-2011 were identified from nationwide administrative registers. Risks of 30-day MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, or cardiovascular death) and all-cause mortality were analyzed by multivariable logistic regression models (adjusted for comorbidities, revised cardiac risk index, cardiovascular pharmacotherapy, body mass index, and surgery type).
A total of 386,818 procedures on 302,459 patients were included; mean age was 54.8years (min-max 20-104), and 44% were men. A total of 1297 (0.34%) had perioperative MACE and 1449 (0.37%) died. Advanced age was associated with increased risks of MACE (odds ratio [OR], 1.87; 95% CI, 1.78-1.98 per 10-year high) and mortality (OR, 1.87; 95% CI, 1.78-1.96 per 10-year high). A total of 21,511 procedures were performed on patients >80-90years old, and 1662 on patients >90years. The numbers of MACE and crude mortality rates were 331 (1.7%) and 388 (2.0%) among >80-90years old, and 50 (3.0%) and 67 (4.0%) for those aged >90years.
The risk of mortality and major adverse cardiovascular events within 30days after surgery increased with advanced age. However, despite advanced age, the absolute event rates appeared to be relatively modest and around 4% for people aged above 90years.
高龄会增加围手术期心血管并发症的风险，可能导致老年患者不愿接受手术。我们在一个接受择期手术的全国性患者队列中研究了高龄对围手术期主要不良心血管事件（MACE）和死亡率的影响。
从全国性行政登记册中确定了所有在 2005-2011 年接受非心脏择期手术、年龄≥20 岁的丹麦患者。使用多变量逻辑回归模型（调整了合并症、修正后的心脏风险指数、心血管药物治疗、体重指数和手术类型）分析了 30 天内 MACE（非致命性缺血性中风、非致命性心肌梗死或心血管死亡）和全因死亡率的风险。
共纳入 302459 名患者的 386818 例手术；平均年龄为 54.8 岁（最小 20 岁，最大 104 岁），44%为男性。共有 1297 例（0.34%）发生围手术期 MACE，1449 例（0.37%）死亡。高龄与 MACE 风险增加相关（比值比 [OR]，每增加 10 岁高 1.87；95%置信区间，1.78-1.98）和死亡率（OR，每增加 10 岁高 1.87；95%置信区间，1.78-1.96）。共有 21511 例手术在>80-90 岁患者中进行，1662 例手术在>90 岁患者中进行。>80-90 岁患者中 MACE 和粗死亡率分别为 331 例（1.7%）和 388 例（2.0%），>90 岁患者分别为 50 例（3.0%）和 67 例（4.0%）。
手术后 30 天内的死亡率和主要不良心血管事件的风险随年龄增长而增加。然而，尽管年龄较大，但对于年龄超过 90 岁的人，绝对事件发生率似乎相对较低，约为 4%。
