Surgery News - January 2009 - (Page 11) JANUARY 2009 • SURGERY NEWS THORACIC 11 Octogenarians Fare Well After Cardiac Surgery BY MITCHEL L. ZOLER Else vier Global Medical Ne ws N E W O R L E A N S — Patients aged 80 years and older who underwent cardiac surgery had a subsequent life expectancy that was as good as the current average survival rate for similarly aged people in the general U.S. population, according to three separate reports presented at annual scientific sessions of the American Heart Association. Cardiac surgery “is a viable option for selected patients aged 80 and older,” Dr. Paul Kurlansky said at the meeting. Chronologic age alone should not be a criterion for deciding whether an elderly patient should be offered cardiac surgery, added Dr. Kurlansky, an ACS Fellow who is a cardiothoracic surgeon and director of research at the Florida Heart Research Institute in Miami. His report reviewed the experience of 1,062 consecutive patients aged 80-99 years who underwent coronary artery bypass grafting (CABG) during 1989-2001 at Mount Sinai MedPostop actuarial ical Center, a comsurvival closely munity hospital in matched the life Miami Beach. The expectancy for average age of people aged 80 these patients was years and older. 83 years old, and DR. KURLANSKY all of them underwent on-pump procedures. During a mean follow-up of 6 years, actuarial survival following surgery was about 6 years, which closely matches the current life expectancy for people aged 80 years in the United States. “Without surgery, their survival would be very short. If survivorship is 5 or 6 years [with surgery], you are offering these patients something that they wouldn’t otherwise have,” he said. In addition, a “very remarkable” finding was how they were doing overall and how they perceived their health. The Short Form–36 health-status questionnaire was completed by 545 of the patients during an in-person or telephone interview an average of 3 years after hospital discharge. The results showed that their self-rated physical- and mentalhealth scores very closely matched the scores of aged-matched norms for the U.S. population, Dr. Kurlansky reported. His analysis also showed that during the 12-year period reviewed, the rate of in-hospital mortality in patients undergoing CABG at Mount Sinai steadily fell from a high of nearly 15% in 1989 to a rate of just over 2% by 2001. The second report at the meeting reviewed 8,796 patients who underwent aortic valve surgery, with or without concurrent CABG, at eight medical centers in northern New England during 1989-2006. This included about 1,000 patients aged 80-84 years, and about 350 patients aged 85 years or older. The median survival rate following surgery was about 7 years among both patients aged 80-84 years and those aged 85 years and older. Expected survival rates in the general U.S. population among people 80-84 years is also 7 years, and 5 years for those aged 85 and older, said Donald S. Likosky, Ph.D., a health policy analyst at Dartmouth Medical School in Lebanon, N.H. The survival rates in the elderly cardiac surgery patients were similar whether they under- went valve surgery only or had combined valve surgery and CABG. The third report at the meeting reviewed 203 patients aged 80 or older (average age 83 years) who underwent aorticvalve surgery at the Methodist-DeBakey Heart Center in Houston during 19772008. A third of the patients also had concurrent CABG. The average perioperative mortality in these patients was about 6%, not significantly different from the average 4% perioperative mortality in 1,020 pa- tients aged 79 or younger (average age 63 years) who also had aortic valve surgery, and in some cases CABG, at the Methodist-DeBakey Heart Center during the same period, Dr. Gerald M. Lawrie reported in a poster. He and his associates did not compare long-term mortality rates in their octogenarian patients with those of age-matched norms. 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Table of Contents Feed for the Digital Edition of Surgery News - January 2009 Surgery News - January 2009 Contents The 20/20 Vision Intent to Prevent News From the College: The Year Ahead Thoracic: Tracheal Triumph Practice Trends: Making the Grade Surgery News - January 2009 Surgery News - January 2009 - Contents (Page 1) Surgery News - January 2009 - Contents (Page 2) Surgery News - January 2009 - Contents (Page 3) Surgery News - January 2009 - Contents (Page 4) Surgery News - January 2009 - Contents (Page 5) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 6) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 7) Surgery News - January 2009 - News From the College: The Year Ahead (Page 8) Surgery News - January 2009 - News From the College: The Year Ahead (Page 9) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 10) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 11) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 12) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 13) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 14) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 15) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 16)
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