Coronary artery bypass grafting in octogenarians: clinical and economic outcomes at community-based healthcare facilities.

ABSTRACT

BACKGROUND: Results of recent studies from high-volume academic centers suggest that coronary artery bypass grafting (CABG) is becoming safer to perform in octogenarians. Similar data from community-based facilities do not exist. OBJECTIVE: To assess the clinical and economic outcomes of nonemergency CABG in 338 octogenarians at 27 community-based facilities across the United States. STUDY DESIGN: Retrospective cohort analysis. PATIENTS AND METHODS: Multivariate analyses were used to compare (1) in-hospital mortality rates, (2) rates of discharge to extended-care facilities, (3) lengths of stay, and (4) in-hospital costs between octogenarians and younger patients. RESULTS: Of 338 patients 80 years or older, the in-hospital mortality rate was higher (4.7% vs 2.1%; P = .002), the rate of discharge to extended-care facilities was greater (24.9% vs 4.8%; P < .001), the length of stay was longer (9.6 vs 7.9 days; P < .001), and in-hospital costs were higher ($20,188 vs $18,196; P < .001) compared with patients younger than 80 years. After adjusting for several covariates, we found that octogenarians were at significantly greater risk of experiencing in-hospital deaths (odds ratio, 4.6; P = .001), of being discharged to extended-care facilities (odds ratio, 28.4; P < .001), and of having longer lengths of stay (difference, 0.7 days; P = .002) than were patients aged 50 to 59 years. CONCLUSION: At these 27 community-based facilities, the in-hospital mortality for nonemergency CABG in octogenarians was 4.7%; however, nearly 25% of surviving octogenarians were discharged to extended-care facilities.