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Clinical Investigations: SURGERY |

Cost, Outcome, and Functional Status in Octogenarians and Septuagenarians After Cardiac Surgery*

Milo Engoren, MD, FCCP; Cynthia Arslanian-Engoren, PhD, RN, CNS; Donna Steckel, BSN, RN; Julie Neihardt, BSN, RN; Nancy Fenn-Buderer, MS
Author and Funding Information

*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@pol.net



Chest. 2002;122(4):1309-1315. doi:10.1378/chest.122.4.1309
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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.

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