Background We analyzed the short-term and mid-term outcomes as well as the health-related quality of life (HRQOL) of octogenarians undergoing elective and urgent cardiac surgery.

Patients and Methods We retrospectively identified 688 consecutive octogenarians who underwent cardiac surgery at our center between January 2012 and December 2019. A propensity score matching was performed which resulted in the formation of 80 matched pairs. The patients were interviewed and the Short Form-36 survey was used to assess the HRQOL of survivors. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model.

Results The median age of the matched cohort was 82 years (p = 0.937), among whom, 38.8% of patients were female (p = 0.196). The median EuroSCORE II of the matched cohort was 19.4% (10.1–39.1%). The duration of postoperative mechanical ventilation was found to be independently associated with in-hospital mortality (odds ratio: 1.01 [95% confidence interval: 1.0–1.02], p = 0.038). The survival rates at 1, 2, and 5 years was 75.0, 72.0, and 46.0%, respectively. There was no difference in the total survival between the groups (p = 0.080). The physical health summary score was 41 (30–51) for the elective patients and 42 (35–49) for the nonelective octogenarians (p = 0.581). The median mental health summary scores were 56 (48–60) and 58 (52–60), respectively (p = 0.351).

Conclusion Cardiac surgery can be performed in octogenarians with good results and survivors enjoy a good quality of life; however, the indication for surgery or especially for escalation of therapy should always be made prudently, reserved, and in consideration of patient expectations.

背景 我们分析了接受择期和紧急心脏手术的八十多岁老人的短期和中期结果以及与健康相关的生活质量 (HRQOL)。

患者和方法 我们回顾性地确定了 2012 年 1 月至 2019 年 12 月期间在我们中心接受心脏手术的 688 名连续八十多岁的老人。进行了倾向评分匹配，结果形成了 80 对配对。对患者进行了采访，并使用 Short Form-36 调查来评估幸存者的 HRQOL。多变量分析使用前向逐步（条件）模型结合了二元逻辑回归。

结果 匹配队列的中位年龄为82岁（p  = 0.937），其中38.8%的患者为女性（p  = 0.196）。匹配队列的 EuroSCORE II 中位数为 19.4% (10.1-39.1%)。发现术后机械通气的持续时间与住院死亡率独立相关（优势比：1.01 [95% 置信区间：1.0-1.02]，p  = 0.038）。1、2 和 5 年的生存率分别为 75.0、72.0 和 46.0%。两组之间的总生存率没有差异（p  = 0.080）。选择性患者的身体健康总结评分为 41 (30-51)，非选择性的 80 多岁患者的身体健康总结评分为 42 (35-49) ( p = 0.581）。心理健康总分中位数分别为 56 (48-60) 和 58 (52-60) ( p  = 0.351)。

结论 80多岁的老人可以进行心脏手术，效果良好，幸存者享有良好的生活质量；然而，手术指征或特别是治疗升级的指征应始终谨慎、保留并考虑患者的期望。