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

Am J Manag Care. 2002 Aug;8(8):749-55.

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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Coronary Artery Bypass / economics*
  • Coronary Artery Bypass / mortality*
  • Female
  • Health Services Research
  • Hospital Costs*
  • Hospital Mortality*
  • Hospitals, Community / standards*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Patient Transfer / statistics & numerical data
  • Regression Analysis
  • Retrospective Studies
  • Skilled Nursing Facilities / statistics & numerical data
  • United States / epidemiology