Katz N M, Hannan R L, Hopkins R A, Wallace R B
Department of Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
Ann Thorac Surg. 1995 Jul;60(1):96-100; discussion 100-1.
With emphasis today on cost containment in health care, the results and costs of cardiac operations in elderly patients are being scrutinized.
Our computerized database was used to obtain the characteristics of patients undergoing cardiac operations from January 1990 to July 1994. A study group of 628 patients aged 70 years and over was identified, and comparisons were made between them and adult patients less than 70 years of age.
In the elderly group the 30-day mortality was 33 of 628 (5.3%), and the overall hospital mortality was 40 (6.4%). During this time the 30-day mortality for all adult patients less than 70 years old was 49 of 1787 (2.7%; p < 0.003) and the hospital mortality was 59 (3.3%; p < 0.001). The mean length of postoperative hospital stay (days +/- standard error) in all surviving patients aged 70 years and over was 11.6 +/- 0.4 days, compared with 8.5 +/- 0.2 days in patients less than 70 years old (p < 0.001). Over the time of the study the length of stay in patients less than 70 years old declined from 9.6 +/- 0.4 to 7.2 +/- 0.6 days, whereas it stayed the same for elderly patients. The 30-day mortality and length of stay increased with the risk category of the Parsonnet model. The mean hospital charge for patients aged 70 and over was 114% of that for younger patients.
Although mortality, length of stay, and hospital charge are increased in patients 70 years of age and over, they are not excessively so. The results support the continued performance of cardiac surgical procedures in select elderly patients.
鉴于当今医疗保健领域对成本控制的重视，老年患者心脏手术的结果和成本正受到审视。
利用我们的计算机化数据库获取1990年1月至1994年7月接受心脏手术患者的特征。确定了一个由628名70岁及以上患者组成的研究组，并将他们与70岁以下的成年患者进行比较。
老年组628例患者中30天死亡率为33例（5.3%），总体医院死亡率为40例（6.4%）。在此期间，所有70岁以下成年患者的30天死亡率为1787例中的49例（2.7%；p<0.003），医院死亡率为59例（3.3%；p<0.001）。所有70岁及以上存活患者的术后住院平均天数（天±标准误）为11.6±0.4天，而70岁以下患者为8.5±0.2天（p<0.001）。在研究期间，70岁以下患者的住院天数从9.6±0.4天降至7.2±0.6天，而老年患者的住院天数保持不变。30天死亡率和住院天数随Parsonnet模型的风险类别增加而增加。70岁及以上患者的平均住院费用是年轻患者的114%。
尽管70岁及以上患者的死亡率、住院天数和住院费用有所增加，但增幅并不过大。这些结果支持在特定老年患者中继续进行心脏外科手术。
