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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1510-1517, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KJ Tuman, RJ McCarthy, H Najafi and AD Ivankovich
Two thousand patients undergoing coronary artery bypass grafting with
cardiopulmonary bypass were prospectively studied to compare the influence
of age on the incidence of neurologic, cardiac, and other complications.
Postoperative neurologic events were found in 56 (2.8%) patients, with an
incidence in patients > or = 75 years (8.9%) more than twice that of
patients 65 to 74 (3.6%) and nine times larger than in patients < 65
(0.9%). Cardiac complications did not differ between age groups except for
low cardiac output state, which occurred 1.7 times more frequently in
patients > or = 75 years compared with those < 65. Patients with
postoperative neurologic events had a ninefold increase in mortality--35.7%
versus 4.0%. Logistic regression analysis demonstrate the most important
predictors of a postoperative neurologic event to be age, preoperative
neurologic abnormality, recent myocardial infarction, and duration of
cardiopulmonary bypass. The risk of neurologic complications increases
disproportionately to the risk of cardiac complications in the elderly
undergoing coronary artery bypass grafting with cardiopulmonary bypass.
Despite neurologic improvement (32 of 56 patients), a postoperative
neurologic event was second only to low cardiac output state as the
postoperative complication most highly associated with in-hospital death.
These results are important for decisions regarding selection of candidates
for coronary artery bypass grafting and for prediction of surgical outcome.
ARTICLES
Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
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