Cardiac surgery in the octogenarian: evaluation of risk, cost, and outcome.

BACKGROUND: Nationwide, cardiac surgery is being performed more frequently in patients aged 80 years and older. METHODS: One hundred four octogenarians undergoing a variety of heart-lung procedures were prospectively studied between 1995 and 1998 for comparison with similar patients aged 65 to 75 years (n = 351). RESULTS: Octogenarians were more likely to be of female gender, and be nondiabetic than the younger group. The 30-day mortality rate for patients aged 65 to 75 years was 3.4% (12 of 351 patients), versus 13.5% (14 of 104) for patients aged 80+ (p = 0.0004), which ranged from 2% (1 of 50) in nonemergent coronary artery bypass grafting to 75% (3 of 4) in double valve procedures. Complications occurring more frequently in octogenarians were severe low output state, reintubation, and atrial fibrillation. Elders experienced a longer intensive care (69.2 versus 43.3 hours, p = 0.002) and postoperative stay (10.09 versus 7.45 days, p = 0.001), and were discharged to a skilled nursing facility more often than younger patients (47% versus 21.1%, p = 0.0001). Total direct costs were $4,818 higher in the octogenarian group (p = 0.0007). CONCLUSIONS: Although emergency operations and complex procedures carried high risks for the octogenarian, the majority of these patients can be offered operation with short-term morbidity, mortality, and resource use that only modestly exceeds that of younger patients.

Primary depressives with secondary alcoholism compared with alcoholics and depressives.

While a subset of depressed patients are believed to "self-medicate" their depression with alcohol, there are no studies comparing the phenomenological and diagnostic characteristics of patients with primary depression and secondary alcoholism with those of patients with depression or alcoholism alone. In this study, we compared 11 patients from each of these three diagnostic groups in terms of past history and current clinical presentation. The patients were matched for age, sex, and level of function. Comorbid patients were most likely to meet criteria for sedative dependence and panic disorder, and had higher scores on the Hamilton Anxiety Scale. In addition, they scored higher on a hypomania scale and had more first-degree relatives with a history of drug abuse.