EFFECT OF ADVANCING AGE ON COST AND OUTCOME OF CORONARY-ARTERY BYPASS-GRAFTING

The clinical and billing records of 250 patients (173 men and 77 women) undergoing isolated coronary artery bypass grafting between 1987 and mid-1990 were retrospectively reviewed to determine charges and clinical results as related to age. Patients were stratified by age into five groups of 50 consecutive patients each: group 1, less than 50 years of age; group 2, 50 to 59 years; group 3, 60 to 69 years; group 4, 70 to 79 years; and group 5, 80 years or older. The groups were compared in regard to perioperative clinical variables, long-term follow-up, and total charges. Group 5 had significantly more postoperative complications than the other four groups (p < 0.05). In addition, length of postoperative hospitalization was significantly longer in group 5 compared with groups 1, 2, and 3 (p < 0.05), and operative mortality in group 5 (20%) was significantly higher than that in the other four groups. The mean total charges for group 5 were $73,399, which was significantly higher than the totals in the other four groups (p < 0.05). Actuarial 3-year survival for the hospital survivors was 87%, 89%, 78%, 82%, and 60% for groups 1, 2, 3, 4, and 5, respectively (p < 0.001). Postoperative performance as measured by the Karnofsky scale was significantly lower in group 5 than in groups 1 and 2 (p < 0.05). These data support the premise that elderly patients undergoing coronary artery bypass grafting have more complications, longer hospitalizations, and higher operative mortality than younger patients. With increasing age, coronary artery bypass grafting entails a greater expenditure of resources with inferior benefit as measured by long-term survival and function.