Open heart surgery in octogenarian patients in a University Hospital in Bogota, Colombia 2019- 2022: A cross-sectional study of 57 patients

Abstract

Abstract Background Life expectancy and the requirement for highly complex cardiovascular surgical procedures in people over 80 years of age have increased. It has been shown that the clinical and sociodemographic characteristics of this age group are associated with an increased risk of postoperative complications. In Colombia, there is little data that demonstrates the associations that determine the risk of complications in these interventions in this population. Methods Cross-sectional study of a database of 57 patients undergoing cardiovascular surgery at a health service provider institution in Bogotá, Colombia between 2019 and 2022. Univariate analysis of qualitative and quantitative variables was performed, and bivariate analysis by type of surgery and complications with test of hypothesis and p-value. Additionally, a Random Forest model was performed for the variables associated with the outcomes of interest. Results The median age was 82 years (IQR 81-83) and 39 patients (68.4%) were men. The most frequent clinical antecedents were arterial hypertension 49 (86.0%), Non-ST Elevation Myocardial Infarction (NSTEMI) 26 (45.6%), ST- Elevation Myocardial Infarction (STEMI) 9 (15.8%), and hypothyroidism 14 (24.6%). A total of 41 (71.9%) coronary artery bypass grafts (CABG), 1 (3.5%) surgical aortic valve replacements (SAVR), 10 (17.5%) combined procedures, 1 (1.8%) mitral valve replacement (MVR), 2 (3.5%) trans catheter aortic valve replacement (TAVR) and 2 (3.5%) other procedures were performed. The mortality rates were overall 15.8%, CABG 4.9%, and for combined procedures 40%. The most frequent complications were atrial fibrillation in fourteen patients (24.6%), delayed sternal closure in five patients (8.8%), cardiogenic shock in five patients (8.8%), septic shock (8.8%), acute kidney failure (8.8%). The significant variables for complications were history of hypothyroidism (p<0.001), length of stay at intermediate care (p=0.03), and age (p=0.021). The Random Forest model determined that hypothyroidism was the antecedent that contributed the most to classify patients who underwent cardiovascular surgery and presented complications. Discussion This study is one of the first in Colombia to describe the sociodemographic characteristics of octogenarians taken to emergency cardiovascular surgery. There were no cerebrovascular accidents (CVAs), which may be a favorable indicator of our screening study protocols. In our study, 52.6% of complications were presented, a higher proportion than that reported in the literature. The procedures were performed by different surgical groups with different experience curves. It is considered that the sample size does not allow conclusions to be drawn, therefore more epidemiological studies are required in this area. Conclusion Octogenarian patients undergoing cardiovascular surgery have a higher risk of complications and death. For this reason, it is considered important to consider different treatment approaches.