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Derivation and Validation of Prognosis-Based Age Cutoffs to Define Elderly in Cardiac Surgery.
- Source :
- Circulation: Cardiovascular Quality & Outcomes; Jul2016, Vol. 9 Issue 4, p424-431, 8p
- Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>The age cutoff to define elderly is controversial in cardiac surgery, empirically ranging from ≥65 to ≥80 years. Beyond semantics, this has important implications as a starting point for clinical care pathways and inclusion in trials. We sought to characterize the relationship between age and adverse outcomes in patients undergoing cardiac surgery and to derive and validate prognosis-based age cutoffs.<bold>Methods and Results: </bold>Six thousand five hundred seventy one consecutive adult patients undergoing cardiac surgery at 3 hospitals in the United States and Canada were included in the cohort. Logistic regression models and generalized additive models with thin-plate splines were fit to the data. The age distribution was 50 to 59 years in 1244 (18.9%), 60 to 69 years in 2144 (32.6%), 70 to 79 years in 2000 (30.4%), ≥80 years in 1183 (18.0%) patients. After controlling for sex and type of operation, the relationship between age and 30-day operative mortality was found to be nonlinear. Receiver operating characteristic analysis showed that the optimal cutoffs to identify older patients at higher risk of operative mortality were greater than 74, 78, and 75 years for isolated coronary bypass, isolated valve surgery, and coronary bypass plus valve surgery, respectively. These age cutoffs were validated in an independent cohort.<bold>Conclusions: </bold>The relationship between age and operative mortality is not linear, manifesting a steeper rise after age 75 for coronary bypass and approaching octogenarian age for isolated valve surgery. Rather than using arbitrary age cutoffs to define elderly, the outcomes-based cutoff of ≥75 years should be used to identify the population of older adults that has higher risk and may benefit from preoperative geriatric evaluation and optimization. [ABSTRACT FROM AUTHOR]
- Subjects :
- AGE distribution
GERIATRIC assessment
CHAOS theory
COMPARATIVE studies
DECISION making
CARDIAC surgery
RESEARCH methodology
EVALUATION of medical care
MEDICAL cooperation
PHARMACOKINETICS
RESEARCH
RESEARCH evaluation
RISK assessment
LOGISTIC regression analysis
EVALUATION research
TREATMENT effectiveness
PREDICTIVE tests
ACQUISITION of data
PATIENT selection
RECEIVER operating characteristic curves
KAPLAN-Meier estimator
ODDS ratio
Subjects
Details
- Language :
- English
- ISSN :
- 19417713
- Volume :
- 9
- Issue :
- 4
- Database :
- Supplemental Index
- Journal :
- Circulation: Cardiovascular Quality & Outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 117550706
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.115.002409