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Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature277099
Source
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7
Publication Type
Article
Date
Feb-2016
Author
Kristinn Thorsteinsson
Kirsten Fonager
Charlotte Mérie
Gunnar Gislason
Lars Køber
Christian Torp-Pedersen
Rikke N Mortensen
Jan J Andreasen
Source
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Comorbidity
Coronary Artery Bypass - mortality
Coronary Artery Disease - mortality - surgery
Denmark - epidemiology
Elective Surgical Procedures - mortality
Emergency Treatment - mortality
Female
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Postoperative Complications - mortality
Retrospective Studies
Abstract
An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.
All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves.
A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (=80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients 80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25).
Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
Notes
Comment In: Eur J Cardiothorac Surg. 2016 Feb;49(2):397-826242898
PubMed ID
25698155 View in PubMed
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Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.

https://arctichealth.org/en/permalink/ahliterature282560
Source
N Engl J Med. 2017 05 04;376(18):1737-1747
Publication Type
Article
Date
05-04-2017
Author
Kristian Kragholm
Mads Wissenberg
Rikke N Mortensen
Steen M Hansen
Carolina Malta Hansen
Kristinn Thorsteinsson
Shahzleen Rajan
Freddy Lippert
Fredrik Folke
Gunnar Gislason
Lars Køber
Kirsten Fonager
Svend E Jensen
Thomas A Gerds
Christian Torp-Pedersen
Bodil S Rasmussen
Source
N Engl J Med. 2017 05 04;376(18):1737-1747
Date
05-04-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiopulmonary Resuscitation
Denmark
Electric Countershock
Female
Humans
Hypoxia, Brain - epidemiology - etiology
Institutionalization - statistics & numerical data
Intention to Treat Analysis
Male
Middle Aged
Nursing Homes
Out-of-Hospital Cardiac Arrest - complications - mortality - therapy
Risk
Survival Analysis
Volunteers
Abstract
The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied.
We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes.
Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P
PubMed ID
28467879 View in PubMed
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Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature284232
Source
Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):792-8
Publication Type
Article
Date
Jun-2016
Author
Kristinn Thorsteinsson
Jan J Andreasen
Rikke N Mortensen
Kristian Kragholm
Christian Torp-Pedersen
Gunnar Gislason
Lars Køber
Kirsten Fonager
Source
Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):792-8
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Coronary Artery Bypass - methods
Coronary Artery Disease - mortality - surgery
Denmark - epidemiology
Female
Humans
Kaplan-Meier Estimate
Longevity
Male
Middle Aged
Nursing Homes - statistics & numerical data
Proportional Hazards Models
Survival Rate - trends
Time Factors
Abstract
Data on nursing home admission in patient's =80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort.
All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012.
A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients
Notes
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PubMed ID
26969738 View in PubMed
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