Early and late outcomes after isolated coronary artery bypass surgery in elderly patients: Results from a multi-institutional Australian database

  • Mr Akshat Saxena, Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Victoria, Australia, Australia
  • Dr Diem Dinh, Department of Epidemiology and Preventative Medicine, Monash University, Prahran, Vic, Australia
  • Dr Gilbert Shardey, Department of Cardiothoracic Surgery, Malvern Medical Centre, Malvern, Vic., Australia
  • Dr Julian Smith, Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Vic, Australia
  • Dr Andrew Newcomb, Department of Cardiothoracic Surgery, St Vincent’s Hospital, Fitzroy, Vic, Australia

Background: The proportion of elderly (≥ 80 years) patients undergoing coronary artery bypass surgery (CABG) is increasing.
Methods: A retrospective analysis of data, collected by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program between June 2001 and December 2009 was performed. Isolated CABG was performed in 21534 patients; of these, 1664(7.7%) were at least 80 years old (Group 1). Patient characteristics, morbidity, and short-term mortality of these patients were compared with those aged less than 80 years (Group 2). The long-term outcome of Group 1 patients following CABG surgery was compared to an age-adjusted Australian population.
Results: Patients over 80 years old were more likely to be female (36.6% vs. 17.3%, p<0.001) and presented significantly more often with heart failure, hypertension and triple-vessel disease (all p<0.05). The 30-day mortality was higher in Group 1 patients (4.2% vs. 1.5%, p<0.001). Group 1 patients also had an increased risk of complications including stroke (1.3% vs. 0.74%, p<0.001), prolonged (>24 hr) ventilation (14.2% vs. 8.2%, p<0.001), renal failure (7.3% vs. 3.4%, p<0.001) and mean ICU stay (61.7 vs. 42.5 hours, p<0.001). The 5-year survival of elderly patients (74%) was comparable to the age-matched Australian population. Independent risk factors for 30-day mortality in Group 1 patients included preoperative renal failure (p=0.010), congestive heart failure (p=0.014), and a non-elective procedure (p=0.016).
Discussion: Elderly patients who undergo isolated CABG have an increased peri-operative risk profile compared to younger patients. The long-term survival of these patients is comparable to an age-adjusted population.