Influence of age on perioperative major adverse cardiovascular events and mortality risks in elective non-cardiac surgery.

BACKGROUND AND AIMS

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.