Weinberg Laurence, Ludski Jarryd, Carp Bradly, Suh Je Min, Koshy Anoop N, Haywood Cilla, Churilov Benjamin, Lee Dong-Kyu, Yii Michael
Department of Anaesthesia, Austin Health, Heidelberg, Australia.
Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia.
PLoS One. 2025 Sep 8;20(9):e0331755. doi: 10.1371/journal.pone.0331755. eCollection 2025.
This review was aimed at understanding the scope of evidence regarding outcomes and complications in nonagenarians (90-99 years of age) undergoing open cardiac surgery.
The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Review Protocol guidelines. A search of three databases, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, identified articles pertaining to nonagenarians undergoing various open cardiac surgical procedures. No restrictions were applied to study design or publication date.
From the initial 1826 articles identified, we included 28 studies from eight countries in a total of 6411 nonagenarians. The median 30-day mortality rate was 10.5% (IQR 7.2-14.6). Postoperative complication rates were reported in 20 studies (71%), and the median major complication rate was 71.4%. Respiratory, cardiac, renal, neurologic, gastrointestinal, and/or infectious complications were reported in 19%, 20%, 14%, 18%, 5%, and 9% of cases, respectively. The median length of hospital stay was 12.5 days (IQR 10.4-18.0). No studies reported unplanned readmissions to the intensive care unit or detailed patient-centered outcome measures.
Although age alone should not preclude nonagenarians from undergoing cardiac surgery, the procedure is associated with a significantly elevated risk of morbidity and a relatively high mortality rate. The review findings emphasize the need for international registry data to identify risk factors associated with adverse outcomes, explore strategies to decrease the risk of major complications, and improve postoperative quality of life. Moreover, creating and implementing uniform preoperative frailty assessments, and correlating them with surgical outcomes, will be crucial. Developing standardized patient-reported experience and outcome measures will also be imperative. Scoping review registered on OSF registries (https://osf.io/4mg7n).
本综述旨在了解90至99岁高龄患者接受心脏直视手术的结局和并发症的证据范围。
本综述按照系统评价和Meta分析的首选报告项目（PRISMA）扩展的范围综述方案指南进行。检索了三个数据库，即MEDLINE、EMBASE和Cochrane对照试验中央注册库，以确定与接受各种心脏直视手术的高龄患者相关的文章。对研究设计或发表日期未作限制。
从最初识别出的1826篇文章中，我们纳入了来自八个国家的28项研究，共6411名高龄患者。30天死亡率中位数为10.5%（四分位间距7.2 - 14.6）。20项研究（71%）报告了术后并发症发生率，主要并发症发生率中位数为71.4%。分别有19%、20%、14%、18%、5%和9%的病例报告了呼吸、心脏、肾脏、神经、胃肠道和/或感染性并发症。住院时间中位数为12.5天（四分位间距10.4 - 18.0）。没有研究报告重症监护病房的非计划再入院情况或详细的以患者为中心的结局指标。
尽管年龄本身不应成为高龄患者接受心脏手术的障碍，但该手术与发病率显著升高和相对较高的死亡率相关。综述结果强调需要国际注册数据来识别与不良结局相关的危险因素，探索降低主要并发症风险的策略，并改善术后生活质量。此外，创建并实施统一的术前衰弱评估，并将其与手术结局相关联，将至关重要。制定标准化的患者报告体验和结局指标也势在必行。范围综述已在OSF注册库（https://osf.io/4mg7n）注册。
