Cardiac surgery in the elderly patient.

BACKGROUND As life expectancies rise and the number of persons over age 75 in the population increases, the proper treatment of elderly cardiac patients is becoming a matter of ever greater medical and political importance. METHODS In collaboration with the German Federal Quality Assurance Office (Bundesgeschäftsstelle Qualitätssicherung, BQS), the authors analyzed the risk profiles of elderly patients by means of data sets from all cardiac surgical centers in Germany for the year 2007. The results regarding risk distribution and the morbidity and lethality statistics for isolated coronary surgery were derived from the complete, nationwide BQS data pool, containing information on a total of 47,881 operations. Data on quality of life and long-term survival were obtained from a selective literature search using Medline. RESULTS Compared to patients under age 65, those over age 75 have significantly more prognosis-determining comorbidities and risk factors. Accordingly, complication rates and lethality are higher in the latter age group (for example, there is a 4.3-fold relative risk elevation for renal dysfunction, a 3.0-fold elevation for neurological complications, and 3.7-fold elevation for in-hospital lethality). The patient's chronological age is a risk factor for lethality and morbidity after coronary surgical procedures. CONCLUSIONS The lethality risk of a bypass operation can be predicted very accurately with the aid of modern scoring systems. Successful cardiac surgical procedures can return the patient to a normal life expectancy and quality of life for his or her age group.