Preserved Quality of Life in Octogenarians After Cardiac Surgery “Pride Cometh Before the Fall”

See related article on pages 48–53. In the accompanying article the authors have done something that many cardiothoracic surgeons should perform more often—that is query their postoperative patients periodically to find out their mental and physical status. All surgeons carefully measure their operative mortality and morbidity rates and act on any one of these when they are not up to national standards. The Wolverhampton, UK cardiac surgeons noticed that they were more frequently asked to perform cardiac surgery on patients who were 80 years of age or more. This was especially noticeable when catheter based aortic valve replacement became a common procedure in their unit. As this seemed to be a departure from their usual practice, they decided to send out a health survey (SF12) to the 308 patients who were still living and more than 2 years from their operation. They divided the respondents into 3 groups based on their survival from operation—o3 years—61 patients; 3–5 years—86 patients; and 45 years—87 patients returned questionnaires. They found no difference in the mental and physical scores between all groups. They concluded that the quality of life for octogenarians undergoing cardiac surgery is preserved regardless of the time interval from and the type of surgery (coronary artery bypass grafting, isolated valve, and complicated) performed. These results appeared to justify the aggressive surgical approach and we assume that they are still using the same criteria for operable patients in Wolverhampton. So did these impressive results raise any questions as to the validity of the authors conclusions. In my opinion these results should be taken with a grain of salt and the authors should consider performing another study with different methodology. First of all we have data from patients at widely different time periods from surgery where different operations were performed. It would be very helpful if the SF-12 data and other measures of general health were measured at regular intervals