Impact of perioperative course during cardiac surgery on outcomes in patients 80 years and older

Abstract Objectives The study aim was to describe the association between preoperative characteristics, intraoperative and postoperative factors, and mortality and morbidity after open-heart surgery among patients aged 80 years and older. Methods This is a retrospective multi-center register study based on prospectively collected data of all patients 80 years and older undergoing open-heart surgery in Western Denmark from 1999 to 2016. Logistic regression was used to estimate the association between preoperative characteristics, intraoperative and postoperative factors, and mortality or morbidity. Bonferroni correction was used for multiple comparisons. Results The study population included 2,342 patients aged 80 years and older undergoing open-heart surgery. We observed an association between severely impaired preoperative renal function and death within one year post surgery; odds ratio (OR) of 4.6 (95% CI: 2.7-7.2). Furthermore, renal clearance below 40 ml/min and prolonged cardiopulmonary bypass time of more than 180 minutes were associated with a probability of death within one year exceeding 50%. Adjusted OR for death within one year increased significantly if patients' postoperative length of stay in intensive care was ≥ three days (OR 5.9; 95% CI: 4.1-8.6), and if postoperative mechanical ventilation lasted ≥ two days (OR 7.5; 95% CI: 4.1-13.9). Various preoperative and intraoperative characteristics were associated with in-hospital dialysis, in particular cardiopulmonary bypass time >180 minutes: OR=11.6 (95% CI: 4.7-28.5). Conclusions Our findings emphasize that careful referral regarding procedural burden is important among the very old patients. The study findings may give support to informed patient discussions about prognosis and recovery.