A. A. Haider1, A. Azim1, M. Bravo1, R. Latifi1, J. Goldberg1 1New York Medical College,Department Of Surgery,Valhalla, NY, USA
Introduction: As the US population ages, the number of octogenarian (≥80 years) population with coronary artery disease undergoing coronary artery bypass graft (CABG) is increasing. Studies have suggested that centers who manage a higher proportion of these patients may have better outcome for this high risk population. The aim of this study was to determine if centers that manage higher proportion of octogenarian patients undergoing CABG have better outcomes.
Methods: The National Inpatient Sample was abstracted for all patients undergoing CABG for 3 years. Hospitals were divided into 4 groups of quartiles based on the percentage of their total CABG patient’s ≥80 years. Outcome measures were mortality and failure-to-rescue (death after a complication) and overall complications (Stroke, UTI, pneumonia, respiratory failure, DVT, PE, iatrogenic PTX etc). Multivariate regression models were created adjusting for age, gender, Charlson comorbidity index, disease severity, hospital volume, and nature of admission (elective/emergent).
Results: A total of 141,392 patients from 589 hospitals were included. Mean age was 65.9 ± 10.8 years, 72.3% were male, and mean Charlson Comorbidity Index was 1.39 ±1.42. Overall 10.8% (n=15,265) of the population that underwent CABG was octogenarian. The proportion of octogenarian patients in these hospitals undergoing CABG ranged from 6.7% in the lowest quartile group to 18.3% in the highest quartile group. The overall mortality rate in the octogenarian group was 5.1% and failure-to-rescue rate was 4.2%. Odds of mortality (OR, 0.97; 95% CI, 0.91–1.07) and FTR (OR, 0.99; 95% CI, 0.91–1.09) after CABG were similar at centers with lowest proportion of octogenarian patients compared with centers with higher proportion of octogenarians. Unadjusted rate of complications was higher in centers with higher proportion of octogenarian patients (43.7% vs. 39.8%; p=0.03) however, using multivariate analysis, the adjusted odds of complications remained similar (OR, 1.02; 95% CI, 0.98–1.07)
Conclusion: The overall proportion of octogenarian patients that undergo CABG at a center does not significantly affect its outcome for this group of patients. Octogenarian patients who are managed at hospitals that manage a lower proportion of these patients have similar outcomes. This evidence does not support the need for treating octogenarian patients at centers with higher proportion of CABG patients.