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Klinische Ergebnisse und Lebensqualität von über Achtzigjährigen nach einem herzchirurgischen Eingriff unter besonderer Berücksichtigung der Notfalleingriffe
Klinische Ergebnisse und Lebensqualität von über Achtzigjährigen nach einem herzchirurgischen Eingriff unter besonderer Berücksichtigung der Notfalleingriffe
Objectives: Due to the demographic change in our ageing society cardiovascular diseases are the leading causes of death in industrial nations. These diseases become symptomatic especially in the elderly patients who often require surgery. Reliable data whether octogenarians benefit from surgery, particularly non-elective surgery, hardly exists. The aim of the present study is to assess the quality of life and the outcome of octogenarians undergoing various non-elective cardiac surgeries in comparison to octogenarians undergoing elective cardiac surgery. Furthermore, we want to identify predictors for early and late mortality. Methods: In this retrospective cross-sectional study 202 patients undergoing cardiac surgery in the years 2012-2016 are evaluated. The mean age is 82,29 ± 1,98 years. 87 patients underwent non-elective cardiac surgery from 2012-2016 and are compared with 115 elective patients from 2014. The quality of life was measured by using the short-form 36 (SF-36) questionnaire. Patients were contacted by phone to answer the questionnaire. The survival analysis is performed with Kaplan-Maier. Predictors for early mortality are calculated with logistic regression and for late mortality with Cox-Regression. Results: No significant difference considering the quality of life of the two study groups could be identified. The survival analysis shows that the long-term survival of patients undergoing non-elective surgery was significant poorer (p=0,003) than of patients undergoing elective cardiac surgery. The estimated survival probability of patients undergoing non-elective surgery is 58,0% and 76,0% in patients undergoing elective surgery. The intrahospital mortality and the 30-day-mortality after non-elective surgery in octogenarians is significantly higher than in elective cases. Predictors for an early mortality are bypass time (p=0,001) and postoperative complications (p=0,007). Preoperative non-elective status (p=0,0018), preoperative ventilation and reanimation (p=0,029) as well as postoperative complications (p<0,001) are predictors for late mortality. Conclusions: The presented data show that the quality of life in non-elective cases of octogenarians is comparable to elective ones. However, the survival analysis and postoperative data show that the survival of non-elective patients is shorter than the survival of elective patients. The decision to operate in a non-elective case must remain an individual decision. This decision could be made easier by considering the predictors of mortality and the postoperative quality of life.
Lebensqualität, Herzchirurgie, über Achtzigjährige Patienten
Lang, Andrea Martina
2021
German
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Lang, Andrea Martina (2021): Klinische Ergebnisse und Lebensqualität von über Achtzigjährigen nach einem herzchirurgischen Eingriff unter besonderer Berücksichtigung der Notfalleingriffe. Dissertation, LMU München: Faculty of Medicine
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Abstract

Objectives: Due to the demographic change in our ageing society cardiovascular diseases are the leading causes of death in industrial nations. These diseases become symptomatic especially in the elderly patients who often require surgery. Reliable data whether octogenarians benefit from surgery, particularly non-elective surgery, hardly exists. The aim of the present study is to assess the quality of life and the outcome of octogenarians undergoing various non-elective cardiac surgeries in comparison to octogenarians undergoing elective cardiac surgery. Furthermore, we want to identify predictors for early and late mortality. Methods: In this retrospective cross-sectional study 202 patients undergoing cardiac surgery in the years 2012-2016 are evaluated. The mean age is 82,29 ± 1,98 years. 87 patients underwent non-elective cardiac surgery from 2012-2016 and are compared with 115 elective patients from 2014. The quality of life was measured by using the short-form 36 (SF-36) questionnaire. Patients were contacted by phone to answer the questionnaire. The survival analysis is performed with Kaplan-Maier. Predictors for early mortality are calculated with logistic regression and for late mortality with Cox-Regression. Results: No significant difference considering the quality of life of the two study groups could be identified. The survival analysis shows that the long-term survival of patients undergoing non-elective surgery was significant poorer (p=0,003) than of patients undergoing elective cardiac surgery. The estimated survival probability of patients undergoing non-elective surgery is 58,0% and 76,0% in patients undergoing elective surgery. The intrahospital mortality and the 30-day-mortality after non-elective surgery in octogenarians is significantly higher than in elective cases. Predictors for an early mortality are bypass time (p=0,001) and postoperative complications (p=0,007). Preoperative non-elective status (p=0,0018), preoperative ventilation and reanimation (p=0,029) as well as postoperative complications (p<0,001) are predictors for late mortality. Conclusions: The presented data show that the quality of life in non-elective cases of octogenarians is comparable to elective ones. However, the survival analysis and postoperative data show that the survival of non-elective patients is shorter than the survival of elective patients. The decision to operate in a non-elective case must remain an individual decision. This decision could be made easier by considering the predictors of mortality and the postoperative quality of life.