Cardiac surgery in the elderly patient

Abstract

Background: As life expectancies rise and the number of persons over age 75 in the population increases, the proper treatment of elderly cardiac patients is becoming a matter of ever greater medical and political importance.

Methods: In collaboration with the German Federal Quality Assurance Office (Bundesgeschäftsstelle Qualitätssicherung, BQS), the authors analyzed the risk profiles of elderly patients by means of data sets from all cardiac surgical centers in Germany for the year 2007. The results regarding risk distribution and the morbidity and lethality statistics for isolated coronary surgery were derived from the complete, nationwide BQS data pool, containing information on a total of 47,881 operations. Data on quality of life and long-term survival were obtained from a selective literature search using Medline.

Results: Compared to patients under age 65, those over age 75 have significantly more prognosis-determining comorbidities and risk factors. Accordingly, complication rates and lethality are higher in the latter age group (for example, there is a 4.3-fold relative risk elevation for renal dysfunction, a 3.0-fold elevation for neurological complications, and 3.7-fold elevation for in-hospital lethality). The patient's chronological age is a risk factor for lethality and morbidity after coronary surgical procedures.

Conclusions: The lethality risk of a bypass operation can be predicted very accurately with the aid of modern scoring systems. Successful cardiac surgical procedures can return the patient to a normal life expectancy and quality of life for his or her age group.

Keywords: demographic trends.

Figure 1. Age distribution in cardiac surgery in adults from 1990 to 2007

a) Absolute numbers in age groups: 20–59 years, 60–69 years, 70–79 years, 80 years and older. The age group of the 70- to 79-year-olds increased 7-fold over the time period, and that of people older than 80, 24-fold. b) Proportional distribution in the respective age group. The age group of 70- to 79-year-olds was the largest cohort in 2007. c) Increase in average age of all operated patients with isolated bypass operations from 1990 to 2007. 1990: n=23 733; 1995: n=51 698; 2000: n=61 997; 2007: n=49 788; Mortality: 1990=2.8%, 1995=2.9%, 2000=2.8%, 2007=2.7%. Source: German Society for Thoracic and Cardiovascular Surgery

Figure 2

Long term survival after cardiac surgical procedures in elderly patients compared with normal life expectancy in Germany. The figure was modified from Schmidtler et al. (Thorac and Cardiovasc Surg 2008; 56: 14–19), and data from the Federal Statistical Office were added. AVR=aortic valve replacement, CABG=coronary artery bypass grafting; MVR=mitral valve replacement