News Roundup [abridged Versions Appear In The Paper Journal]

Bypass surgery can be safe for octogenarians

BMJ 2001; 323 doi: (Published 29 September 2001) Cite this as: BMJ 2001;323:712
  1. David Spurgeon
  1. Quebec

    Cardiac bypass surgery can be as safe for 80 year olds as for those in their 70s —and no more costly, says a study published in the Canadian Medical Association Journal (2001;165:759-64).

    The number of octogenarians being referred for cardiac interventions is expected to increase, say the authors, who are with the CADENCE Research Group, Hamilton Health Science, in the department of surgery and the faculty of health sciences at McMaster University in Hamilton, Ontario.

    People aged 85 years and older are the fastest growing segment of Canada's senior population. Yet data related to coronary bypass grafting in elderly patients are inadequate, and considerable debate remains about such procedures in patients 80 or older.

    Because of this, the group reviewed data on patients 70 years and older who had undergone bypass surgery at the Hamilton regional cardiac surgical centre between 1 July 1997 and 30 April 2000. A total of 1034 patients were divided into three groups: young septuagenarians (70-74 years), old septuagenarians (75-79), and those 80 and older. Costs were determined in a subset of 773 patients by using a cost casing system developed at the centre.

    “The three groups were similar with respect to sex distribution and preoperative risk factors,” says the study. “There were no significant differences between the three groups in the mean number of grafts per patient (3.0, 3.1, and 3.0 respectively), the rate of postoperative death (3.3%, 5.7%, and 4.2%), the mean length of stay (11.7, 13.4, and 12.6 days) or the incidence of postoperative myocardial infarction (4.5%, 3.4%, and 4.2%). The total cost of coronary artery bypass grafting per patient did not differ significantly between the three groups.”

    Hamilton Health Sciences' hospitals complete about 1300 cardiac operations each year, about 60% of which are isolated cardiac artery bypass graft procedures. Currently, people aged 70-74 form the largest five year age cohort of patients. Those 70 and older account for 45% of all patients undergoing such procedures there.

    The authors acknowledged several limitations to their study: inclusion of patients from a single institution; its status as a teaching hospital that performs a large number of bypass operations each year; the study's retrospective and observational design; and the small sample of octogenarians. They say long term follow up of elderly patients undergoing these procedures is necessary to determine survival, use of health services, and economic implications for the healthcare system.

    Commenting on the study in the same issue of the journal, Dr William A Ghali of the University of Calgary and Dr Michelle M Graham of the University of Alberta call the results “encouraging” because they add to “an increasing volume of published evidence suggesting reasonable safety of the procedure in elderly patients and probable benefit over medical therapy alone.”

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