Frailty as a Predictor of Surgical Outcomes in Older Patients

Abstract Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

Download Full-text

Comprehensive Perioperative Geriatric Assessments May Predict Surgical Outcomes in a Prospective Study of Older Patients Undergoing Pancreaticoduodenectomy

Gastroenterology ◽

10.1016/s0016-5085(11)64191-7 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-1009

Author(s):

Kevin K. Roggin ◽

Joshua A. Hemmerich ◽

Jeffrey B. Matthews ◽

Mitchell C. Posner ◽

William Dale

Keyword(s):

Prospective Study ◽

Surgical Outcomes ◽

Older Patients ◽

A Prospective Study

Download Full-text

The Impact of Age and Gender on Outcomes of Coronary Artery Bypass Grafting

10.21203/rs.3.rs-17139/v1 ◽

2020 ◽

Author(s):

anthony lemaire ◽

Cassandra Soto ◽

Lauren Salgueiro ◽

Hirohisa Ikegami ◽

Mark J. Russo ◽

...

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Surgical Outcomes ◽

Older Patients ◽

Artery Bypass ◽

Bypass Grafting ◽

The Impact ◽

Adult Cardiac Surgery

Abstract Objective : As the population ages, increasing number of older patients are undergoing adult cardiac surgery. The purpose of the study is to assess the impact of age on postoperative outcomes in patients that undergo coronary artery bypass grafting (CABG).Methods : Patients that are ≥70 years old who underwent CABG were selected from the Nationwide/National Inpatient Sample from 2010 to 2015 using ICD-9-CM diagnosis and procedure codes. The patients who were 70–79 years old were compared to patients aged 80–89 years old to determine if the age difference of the patients had an impact on surgical outcomes. In addition, the gender of the patients 80-89 years old were compared to determine the influence of patient gender on surgical outcomes. The rates of postoperative complications, mortality, hospital length of stay (LOS), and cost were compared using the Chi-square test, multivariable logistic regression analysis, and Wilcoxon rank sum test.Results : A total of 67,568 patients were identified who were ≥70 years old and underwent CABG. Compared to the Septuagenarians, the Octogenarians were more likely to develop cardiac complications (OR [odds ratio] =1.20, 95% CI [confidence interval] 1.12-1.23. They were also more likely to develop 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). The Octogenarians were also more likely to bleed postoperatively (P <0.0001) and have a higher mortality (OR 1.41 95% CI 1.36-1.61, P <0001). 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). 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). 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.Conclusions : Advanced age influences surgical outcomes after CABG. The patients who were ≥80 – 89 years old had worse postoperative outcomes with increased complications and higher mortality compared to the Septuagenarians. Additionally, the Octogenarians who were females had a higher mortality compared to their male counterparts. These findings should help determine treatment options for older patients who need adult cardiac surgery.

Download Full-text