Stoica S et al. (2005) Octogenarians undergoing cardiac surgery outlive their peers—a case for early referral. Heart [10.1136/hrt.2005.064451]

Although cardiac surgery in the elderly is usually successful, these patients have a higher risk of procedure-related mortality and postoperative complications because of their age and comorbidities. This retrospective, single-center study aimed to compare the long-term survival of elderly cardiac-surgery patients (those aged over 80 years) with that of a national cohort matched for age and sex.

The study included 12,461 consecutive patients undergoing cardiac surgery between 1996 and 2003; 706 were aged over 80 years at the time of surgery. Information regarding preoperative variables, operation type and outcomes was collected from a hospital database. The UK National Health Service Strategic Tracing Service was used to determine whether patients were alive 30 days after the last patient's surgery had been performed; length of follow-up ranged from 1 month to 7.6 years. Expected survival was calculated using UK population survival rates obtained from the Government Actuary's Department.

Long-term survival in those over 80 years was lower than expected in the year following surgery, but higher thereafter, with 82.1% surviving for 5 years compared with 55.9% in the general population matched for age and sex. Nonelective surgery was more frequent in the elderly and was related to higher mortality. The authors acknowledge a potential source of bias in patient preselection by referring clinicians, but suggest that cardiac surgery is acceptable for patients aged over 80 years in terms of mortality and morbidity and encourage elective rather than urgent referrals.