Postoperative complications among octogenarians after cardiovascular surgery.
Postoperative complications among octogenarians after cardiovascular surgery.
复制标题
心血管手术后八旬老人的术后并发症。
DOI：
10.1016/s0003-4975(03)00676-3
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
E. Lefrak
中科院分区：
文献类型：
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作者：
S. Barnett;Linda S. Halpin;A. Speir;R. Albus;B. Akl;P. Massimiano;N. Burton;L. Collazo;E. Lefrak
背景：八十多岁的病人通常被认为太脆弱而不能进行心胸外科手术。我们的研究旨在比较80岁以下的患者和80岁以上的老年患者在心脏手术（冠状动脉搭桥术或瓣膜置换术）后的并发症。方法：研究对象均为在弗吉尼亚州北部的两家医疗中心接受过心脏直视手术的患者（n = 8361），包括冠状动脉搭桥术、瓣膜植入或置换术。回顾计算机病历数据库以确定术前危险因素和术后结果。通过单因素和多因素logistic回归确定并发症的预测因素。结果共记录并发症3214例。最常见的并发症是重症监护病房通气时间延长、出血再手术和肺炎。总死亡率为2.4%（8,361人中有204人）。80岁以上患者的死亡率几乎是年轻患者的两倍（4.1%[444 / 18]对2.3%[7,917 / 186]）。年龄大于80岁（优势比= 2.65,95%可信区间= 2.18 ~ 3.22）和男性（优势比= 0.62,95%可信区间= 0.56 ~ 0.69）是单一术后并发症的最佳单因素预测因子。结论老年患者的心脏干预死亡风险是年轻患者的两倍，平均住院时间延长2天。此外，80多岁的老年人非致命性术后并发症的风险明显更高。
BACKGROUNDThe octogenarian patient is often perceived as too fragile to undergo cardiothoracic surgery. Our study aimed to compare postoperative complications in patients aged less than 80 versus elderly patients (80 years or more) after surgical cardiac intervention (coronary artery bypass or valve replacement).METHODSSubjects were all patients (n = 8,361) who had an open-heart procedure, either coronary artery bypass or valve implantation or replacement, at two medical centers located in northern Virginia using the same surgical group. A computerized medical record database was reviewed to determine preoperative risk factors and postoperative outcomes. Predictors of complications were identified by univariate and multivariate logistic regression.RESULTSA total of 3,214 complications were recorded. The most prevalent complications were prolonged ventilation time in the intensive care unit, reoperation for bleeding, and pneumonia. The overall mortality rate was 2.4% (204 of 8,361). Persons aged over 80 years had nearly double the mortality rate compared with younger patients (4.1% [18 of 444] to 2.3% [186 of 7,917]). Age greater than 80 years (odds ratio = 2.65, 95% confidence interval = 2.18 to 3.22) and male gender (odds ratio = 0.62, 95% confidence interval = 0.56 to 0.69) were the best univariate predictors of a single postoperative complication.CONCLUSIONSOctogenarian patients manifested twice the risk of death from a cardiac intervention with an average 2-day longer hospital stay compared with their younger counterparts. Furthermore, octogenarians were at markedly higher risk of nonfatal postoperative complications.