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* From the Departments of Anesthesiology (Dr. Engoren), Cardiovascular Nursing (Ms. Steckel and Ms. Neihardt), and Research (Ms. Fenn-Buderer), St. Vincent Mercy Medical Center, Toledo, OH; and the Division of Acute, Critical, and Long-Term Care (Dr. Arslanian-Engoren), School of Nursing, University of Michigan, Ann Arbor, MI.
Correspondence to: Milo Engoren, MD, FCCP, Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry St, Toledo, OH 43608; e-mail: engoren{at}pol.net
Study objectives: To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery.
Design: Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years.
Patients: One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who underwent cardiac surgery.
Setting: A university-affiliated tertiary care center.
Measurements and results: Compared to septuagenarians, octogenarians were more likely to be widowed (p 
0.001) and to have had preoperative strokes (p 0.05) but were less likely to have diabetes mellitus (p 0.001). They were less likely to have undergone mitral valve surgery (p 0.01) but were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p 0.001). The hospital mortality rate was 6% in the younger group and 9% in the older group (odds ratio, 1.5; 95% confidence interval [CI], 0.5 to 4.5; p > 0.05). In patients undergoing isolated CABG, the mortality rate was 1.4% in the septuagenarians and 8.2% in the octogenarians (odds ratio, 6.2; 95% CI, 0.7 to 52.7; p = 0.12). Despite similar ICU, postoperative, and total lengths of stay, the median hospital direct variable cost was 35% higher for the octogenarians. At late follow-up, octogenarians had lower levels of physical functioning and general health but otherwise had levels of function that were similar to those of septuagenarians.
Conclusion: Cardiac surgery can be performed in the elderly with good hospital and late functional results, but at a higher hospital cost than that for younger patients.
Key Words: cardiac surgery • coronary artery bypass grafting • direct variable cost • functional outcome • octogenarians • septuagenarians • survival
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