(Circulation. 1995;92:85-91.)
© 1995 American Heart Association, Inc.
Articles |
Outcomes of Coronary Artery Bypass Graft Surgery in 24 461 Patients Aged 80 Years or Older
From the Division of Cardiology, Department of Medicine, and the Division of Biometry, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
Correspondence to Eric D. Peterson, MD, MPH, Box 3236, Duke University Medical Center, Durham, NC 27708-3236.
Background Coronary artery bypass graft surgery is
increasingly common in patients of age 
80 years.
Single-institution reviews have cited a wide range of mortality
results after bypass surgery in this age group, in part because of
limited sample sizes. Using claims data, we examined recent national
trends in the use and outcomes of bypass surgery in the very
elderly.
Methods and Results From an examination of Medicare data from
1987 through 1990, we identified 24 461 patients of age 80 years who
underwent bypass surgery. We compared surgical outcomes in these
patients with those in Medicare patients of age 65 to 70 years. We
found that the national use of bypass surgery in patients of age 80
years increased 67% between 1987 and 1990. Compared with patients of
age 65 to 70 years, the very elderly had significantly longer
postoperative hospital stays (mean, 14.3 versus 10.4 days), higher
charges (mean, $48 200 versus $38 000), and greater costs (mean,
$27 200 versus $21 700). In-hospital (11.5% versus 4.4%),
1-year (19.3% versus 7.9%), and 3-year mortality rates (28.8% versus
13.1%) after bypass surgery were also significantly higher in patients
of age 80 years compared with younger patients. Although their
initial surgical risk was high, octogenarians who underwent bypass
surgery had a long-term survival rate similar to that of the
general US octogenarian population.
Conclusions The use of bypass surgery in patients of age 80
years is increasing. These very elderly patients face high surgical
risks and accumulate significant hospital expenses. Further research is
indicated to determine whether the long-term benefits from bypass
surgery in the very elderly outweigh the increased procedural risks.
Key Words: aging • survival • cardiopulmonary bypass • revascularization
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