OUTCOMES OF CORONARY-ARTERY BYPASS GRAFT-SURGERY IN 24461 PATIENTS AGED 80 YEARS OR OLDER

Background Coronary artery bypass graft surgery is increasingly common in patients of age greater than or equal to 80 years. Single-institution reviews have cited a wide range of mortality results after bypass surgery in this age group, in part because of limited sample sizes. Using claims data, we examined recent national trends in the use and outcomes of bypass surgery in the very elderly. Methods and Results From an examination of Medicare data from 1987 through 1990, we identified 24 461 patients of age greater than or equal to 80 years who underwent bypass surgery. We compared surgical outcomes in these patients with those in Medicare patients of age 65 to 70 years. We found that the national use of bypass surgery in patients of age greater than or equal to 80 years increased 67% between 1987 and 1990. Compared with patients of age 65 to 70 years, the very elderly had significantly longer postoperative hospital stays (mean, 14.3 versus 10.4 days), higher charges (mean, $48200 versus $38000), and greater costs (mean, $27200 versus $21700). In-hospital (11.5% versus 4.4%), 1-year (19.3% versus 7.9%), and 3-year mortality rates (28.8% versus 13.1%) after bypass surgery were also significantly higher in patients of age greater than or equal to 80 years compared with younger patients. Although their initial surgical risk was high, octogenarians who underwent bypass surgery had a long-term survival rate similar to that of the general US octogenarian population. Conclusions The use of bypass surgery in patients of age greater than or equal to 80 years is increasing. These very elderly patients face high surgical risks and accumulate significant hospital expenses. Further research is indicated to determine whether the longterm benefits from bypass surgery in the very elderly outweigh the increased procedural risks.