Results
A total of 67,568 patients were identified who were ≥70 years old and
older and underwent CABG. The data from our study shows that patients
who were octogenarians had worse results (Figure 2). Specifically,
compared to the Septuagenarians, the Octogenarians were more likely to
develop more cardiac complications (OR [odds ratio] =1.20, 95% CI
[confidence interval] 1.12-1.23. They were also more likely to
develop more renal complications (OR 1.54 95% CI 1.48-1.61, P
<0001), respiratory complications (OR 1.2, 95% CI 1.2-2.1, P
<0001), and infectious complications (OR=1.41, 95% CI
1.34-1.48, P <0001). These complications lead to poor surgical
outcomes. Our results are supported by previous studies with similar
findings that older patients have worse results compared to younger
patients. The unique study design was to separate elderly patients into
Septuagenarians and Octogenarians allowing for the identification of
important differences in outcomes.
In a study analyzing 8769 patients undergoing cardiac surgery, patients
over the age of 70 were observed to have increased risk of postoperative
complications including pneumonia, arrhythmia, and bleeding [4].
Similarly, a study published in 2011 demonstrated that risk factors for
reoperation due to bleeding were related to older age [8]. As older
patients undergo CABG, it is very useful to be able to risk stratify
these patients and identify which age group above 70 years old have
better outcomes and should be directed to CABG. Conversely, identifying
which patients have worse outcomes can help steer these patients towards
PCI.
The Octogenarians in our study were also more likely to bleed
postoperatively (P <0.0001), and they had a higher mortality
(OR 1.41 95% CI 1.36-1.61, P <0001) (Figure 3). Moreover, the
older patients had a longer postoperative LOS (median 9 days IQR
[interquartile range] 7-13 days compared to the Septuagenarians
(median 8 days IQR 6-11 days). As expected with the longer LOS, the
Octogenarians had an associated increased hospital cost (median $39,152
IQR $30, 0003.84 - $53, 272.84) compared to the Septuagenarians
(median $35,996.16 IQR $27,735.94 - $48,134.38) (Figure 4 and 5).
Furthermore, the female octogenarians had a higher mortality (OR 1.25
95% CI 1.07–1.46) compared to males in the same age group (Figure 1).
The gender difference in the Octogenarians is a critical finding not
previously reported in the literature. These worse outcomes for female
Octogenarians extended to more postoperative complications including
bleeding, respiratory complications, and infections (Figure 6-8).