Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep;17(3):501-6.
doi: 10.1093/icvts/ivt229. Epub 2013 May 24.

Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden?

Heinz Deschka  1 , Romy Schreier, Lemir El-Ayoubi, Stefan Erler, Dirk Müller, Aiman Alken, Gerhard Wimmer-Greinecker
Affiliations

Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden?

Heinz Deschka et al. Interact Cardiovasc Thorac Surg. 2013 Sep.

Abstract

Objectives: In accordance with the rising prevalence of octogenarians undergoing cardiac surgery, these patients utilize an increasing portion of intensive care unit (ICU) capacities, provoking economic and ethical concerns. In this study, we evaluated the outcomes and costs generated by the prolonged postoperative ICU treatment of octogenarians.

Methods: Between July 2009 and August 2010, 109 of 1063 patients required ICU treatment of at least 5 days after cardiac surgery. Patients were retrospectively assigned to either Group A (age <80, n = 86) or Group B (age ≥80, n = 23). Operative risk, mortality, length and costs of ICU treatment were analysed and compared. After 1 year, survival, quality of life (QOL) and functional status were assessed.

Results: Hospital mortality was 31.4% in Group A and 56.5% in Group B. Survivals of discharged patients after 1 year were 83% (Group A) and 80% (Group B), respectively. Log EuroSCORE I of octogenarians was significantly higher (30 ± 17 vs 20 ± 16, P < 0.001). No significant differences (Group A vs Group B) were found between the groups concerning length of ICU treatment (20 ± 21 vs 16 ± 14 days, P = 0.577) or costs (27 205 ± 29 316€ vs 21 821 ± 16 259€, P = 0.812). Functional capacity, calculated by using Barthel index, was high (Group A: 87 ± 22 and Group B: 67 ± 31, P = 0.108) and did not differ significantly between groups. QOL, measured with the short form-12 health survey, did not differ significantly between groups (physical health summary score: P = 0.27; mental health score: P = 0.885) and was comparable with values of the age-adjusted general population.

Conclusions: Presented data propose that advanced age is correlated with a higher mortality, but not with prolonged ICU treatment or higher costs after cardiac surgery. Considering the encouraging functional status and QOL of the survivors, the financial burden caused by octogenarians is justified.

Keywords: Cardiac surgery; Intensive care; Octogenarians; Outcomes; Quality of life.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Total duration of ICU treatment (days).
Figure 2:
Figure 2:
Total costs of ICU treatment (€).
Figure 3:
Figure 3:
Kaplan–Meier survival curves of Groups A and B, P = 0.0081.
Figure 4:
Figure 4:
Group-specific comparison of pre- and postoperative Barthel index and physical (PHS) and mental (MHS) health score of SF-12 survey.
See this image and copyright information in PMC

References

    1. Funkat A, Beckmann A, Lewandowski J, Frie M, Schiller W, Ernst M, et al. Cardiac surgery in Germany 2011: a report on behalf of the German Society of Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg. 2012;60:371–82. doi:10.1055/s-0032-1326724. - DOI - PubMed
    1. Engoren M, Arslanian-Engoren C, Steckel D, Neihardt J, Fenn-Buderer N. Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery. Chest. 2002;122:1309–15. doi:10.1378/chest.122.4.1309. - DOI - PubMed
    1. Melby SJ, Zierer A, Kaiser SP, Guthrie TJ, Keune JD, Schuessler RB, et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg. 2007;83:1651–6. doi:10.1016/j.athoracsur.2006.09.068. - DOI - PubMed
    1. Zingone B, Gatti G, Rauber E, Tiziani P, Dreas L, Pappalardo A, et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg. 2009;87:71–8. doi:10.1016/j.athoracsur.2008.10.011. - DOI - PubMed
    1. Nissinen J, Wistbacka JO, Loponen P, Korpilahti K, Teittinen K, Virkkilä M, et al. Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected. Ann Thorac Surg. 2010;89:1119–24. doi:10.1016/j.athoracsur.2009.12.063. - DOI - PubMed

MeSH terms