Clinical Results and Quality of Life after Nonelective Cardiac Surgery in Octogenarians

 

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Abstract

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.

Authors' Contribution

Shekhar Saha: Data curation, formal analysis, methodology, validation, visualization, writing—original draft, and revisions.

Andrea Lang: Data curation, methodology, and validation.

Julia von der Linden: Data curation, formal analysis, and validation.

Dietmar Wassilowsky: Project administration, validation, writing—review, and editing.

Sven Peterss: Conceptualization, resources, supervision, writing—review, and editing.

Maximilian Pichlmaier: Conceptualization, investigation, methodology, supervision, writing—review, and editing.

Christian Hagl: Conceptualization, resources and software, supervision, writing—review, and editing.

Gerd Juchem: Project administration, supervision, writing—review, and editing.

Dominik Joskowiak: Conceptualization, formal analysis, investigation, methodology, visualization, writing—original draft, and revisions.

Publication History

Received: 23 January 2021

Accepted: 13 April 2021

Article published online:
16 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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