Patient Disposition and Long-Term Outcomes After Valve Surgery in Octogenarians

被引:38
作者
Henry, Linda [1 ]
Halpin, Linda [1 ]
Hunt, Sharon [1 ]
Holmes, Sari D. [1 ]
Ad, Niv [1 ]
机构
[1] Inova Heart & Vasc Inst, Falls Church, VA 22042 USA
关键词
HIGH-RISK PATIENTS; CARDIAC-SURGERY; SOCIAL SUPPORT; GREATER-THAN-OR-EQUAL-TO-80; YEARS; PSYCHOSOCIAL FACTORS; MORTALITY; IMPLANTATION; CARE; CATHETERIZATION; FAILURE;
D O I
10.1016/j.athoracsur.2012.04.073
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Valve surgery is performed routinely in octogenarians. This study explored variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival. Methods. Patients 80 years or older who presented for aortic valve or mitral valve surgery from 2002 to 2010 were included. Baseline demographic, perioperative, and long-term outcomes were captured. Disposition was categorized into 2 groups; home (n = 184) or other facility (n = 123). The National Death Index and Social Security Death Index verified deaths. Results. Mean age was 82.9 +/- 2.5; 46% (140 of 307) were female. Discharge location logistic regression, adjusted for gender (odds ratio [OR] = 1.45, p = 0.17) and European System for Cardiac Operative Risk Evaluation score (OR = 1.09, p = 0.10), predicted that older (OR = 1.18, p < 0.001), unmarried (OR = 2.07, p = 0.006) patients with at least 1 major complication (OR = 3.86, p < 0.001) were more likely to be not discharged home. Kaplan-Meier analysis found significantly lower 1- and 2-year (85.8% vs 94.6%, p = 0.009; 80.1% vs 90.3%, respectively, p = 0.01) cumulative survival in patients not discharged home. A multivariate Cox proportional hazards model demonstrated poorer 1- and 2-year survival (hazard ratio [HR] = 2.56, p = 0.04; HR = 2.06, p = 0.05, respectively). Predictors of follow-up mortality for patients not discharged home were length of stay (OR = 1.06, p = 0.03) and any major complication (OR = 6.90, p = 0.002); lower body mass index was marginally significant (OR = 1.12, p = 0.06). The significant predictor for patients discharged home was length of stay (OR = 1.17, p = 0.002). Conclusions. Octogenarians can expect excellent survival after valve surgery. Those not discharged home had poorer long-term survival. Therefore, adequate resources should be secured so sicker patients receive the appropriate level of care.
引用
收藏
页码:744 / 750
页数:7
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