Results and Predictors of Early and Late Outcomes of Coronary Artery Bypass Graft Surgery in Octogenarians

Objectives: The aim of this study was to investigate early and late outcomes of coronary artery bypass graft (CABG) surgery in a large cohort of octogenarian patients. The results were compared with 2 other age groups including septuagenarians and patients <70 years old. Design: A retrospective study of consecutive patients undergoing CABG surgery using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively. Setting: A university hospital (single institution). Participants: Two thousand nine hundred eighty-five patients undergoing CABG surgery including 282 (9.4%) octogenarians, 852 (28.6%) septuagenarians, and 1851 (62%) patients younger than 70 years old. Interventions: None. Measurements and Main Results: Patient characteristics, hospital mortality, morbidity, length of stay, and long-term survival were analyzed. Octogenarians were more likely female and presented significantly more often with comorbidities such as heart failure, an ejection fraction <30%, peripheral vascular disease, and aortic calcification. Crude hospital mortality was 4.6% (n = 13) in octogenarians compared with 2.2% (n = 19) in septuagenarians and 2.4% (n = 44) in patients <70 years old (p = 0.067). Respiratory failure and gastrointestinal complications occurred more frequently in octogenarians. The stroke rate was 1.6% and similar in the 3 age groups. In multivariate logistic regression analysis, age >80 years was not a predictor of hospital mortality. The length of stay was significantly higher in octogenarians compared with nonoctogenarians (16 ± 24 days v 10 ± 13 days, p < 0.001). Five-year survival was 63% ± 4% in octogenarians and was similar to that of an age- and sex-matched general US population. Conclusions: Excellent results after CABG surgery can be expected in octogenarians, with a minimal increase in postoperative mortality and acceptable postoperative morbidity. Respiratory failure is the main postoperative complication in octogenarians. Recent advances in operative techniques and perioperative management have contributed in improving surgical outcome in these patients compared with historic reports.