Nonelective cardiac surgery in the elderly: is it justified?

Abstract

Objective: Elderly patients might be denied nonelective cardiac surgery because of the perception of poor outcomes and an unacceptable quality of life. In this study we evaluate long-term survival and quality of life in these patients.

Methods: From 1994 to 1999, 262 consecutive patients older than 80 years underwent urgent (n = 223) or emergent (n = 39) cardiac surgery. Of these patients, 160 (61%) underwent coronary artery bypass grafting, 64 (24%) underwent coronary artery bypass grafting plus valve surgery, 17 (7%) underwent valve surgery, and 21 (8%) underwent aortic surgery. Kaplan-Meier survival analysis and quality-of-life assessment were performed, and result were compared with age-adjusted population data. Risk factors for mortality were determined by using Cox regression. The utility of Society of Thoracic Surgeons and EuroSCORE risk scoring were assessed by using area under receiver operating curves.

Results: Early mortality was 11% (n = 29) overall, 7% (n = 16) in urgent cases, and 33% (n = 13) in emergent cases. Five-year survival was 50% (n = 132) overall, 53% (n = 105) in urgent cases, and 36% (n = 18) in emergent cases. There was no difference in 10-year survival between patients undergoing urgent surgical intervention and age-adjusted population data. Among survivors, quality-of-life measures were equivalent to those of the general elderly population. Risk factors for early mortality were age, emergent procedure, aortic procedure, bypass time, and postoperative complication (renal failure, myocardial infarction, cerebrovascular accident, pneumonia, and reoperation for bleeding). Risk factors for late mortality were peripheral vascular disease, emergent procedure, bypass time, and new renal failure. The EuroSCORE and Society of Thoracic Surgeons risk scores were equivalent but only moderately predictive of mortality.

Conclusions: Long-term survival and quality of life after nonelective cardiac surgery can equal that of the general elderly population. Age alone should not disqualify a patient for urgent or emergent cardiac surgery.