Journal Article

Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study

Kristinn Thorsteinsson, Kirsten Fonager, Charlotte Mérie, Gunnar Gislason, Lars Køber, Christian Torp-Pedersen, Rikke N. Mortensen and Jan J. Andreasen

in European Journal of Cardio-Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 49, issue 2, pages 391-397
Published in print February 2016 | ISSN: 1010-7940
Published online February 2015 | e-ISSN: 1873-734X | DOI: https://dx.doi.org/10.1093/ejcts/ezv060
Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study

More Like This

Show all results sharing these subjects:

  • Molecular Biology and Genetics
  • Molecular and Cell Biology

GO

Show Summary Details

Preview

OBJECTIVES

An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.

METHODS

All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan–Meier curves.

RESULTS

A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60–69 years), 10.7 years (70–74 years), 8.9 years (75–79 years) and 7.2 years (≥80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients <60 years, 8% in octogenarians). The long-term mortality rate at 1 and 5 years was 2 and 7% (age <60 years) and 14 and 36% (age >80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13–17%, diabetes 12–21%, stroke 9–11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41–7.50], emergency surgery (HR: 5.23, 95% CI: 4.38–6.25).

CONCLUSION

Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.

Keywords: Coronary artery bypass grafting; Octogenarians; Mortality; Survival; Comorbidity

Journal Article.  4583 words.  Illustrated.

Subjects: Molecular Biology and Genetics ; Molecular and Cell Biology

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content. subscribe or purchase to access all content.