Cardiac Surgery in the Elderly Patient: Geriatric Perspective

by PD Dr. med. Ivar Friedrich, PD Dr. med. Andreas Simm, Joachim Kötting, Dr. med. Frank Thölen, Burkhard Fischer, Prof. Dr. med. Rolf-Edgar Silber in volume 25/2009

We congratulate Friedrichs et al on their article. On the basis of data from the BQS (Bundesgeschäftsstelle Qualitätssicherung, the Federal Office for Quality Assurance) they convincingly showed the notable drop in mortality of elderly patients after bypass surgery. They also point out, rightly, that current, commonly used risk scores—such as the Euro-SCORE—notably overestimate postoperative mortality and are thus of limited usefulness for assessing risk. The authors therefore suggest using a new risk score based on the BQS data.

We think that such a score may be equally inadequate in trying to assess the operative risk in elderly patients. Several studies have shown that functional variables that are collected in the context of geriatric assessment have a substantial influence on the hospital mortality and morbidity of elderly patients. Such factors include dependence on others in activities of everyday life, cognition, mobility, sarcopenia, and symptoms of depression (1, 2). As Silber and colleagues mentioned, considering these factors makes much sense in assessing the operative risk of elderly patients. In June 2009, our group concluded a cohort study evaluating the prospective validity of these parameters, and we have presented initial results at the congress of the American College of Cardiology (3). Sarcopenia (using handgrip strength as a marker), cognitive impairments, and impaired activities of everyday life were associated with a two- to threefold mortality compared with patients without such functional impairments. We wish to encourage all colleagues to include these factors in their work so as to appropriately take into account the particular risk constellation of elderly and very old patients.
DOI: 10.3238/arztebl.2009.0693b

PD Dr. med. Friedrich-Christian Rieß
Herzzentrum, Albertinen-Krankenhaus, Hamburg

Prof Dr. med. Wolfgang von-Renteln Kruse
Medizinisches Zentrum, Albertinen-Krankenhaus, Hamburg

Dr. med. Birgit Frilling
Zentrum für Geriatrie und Gerontologie
an der Universität Hamburg
Albertinen-Haus
Selhopsweg 8–22
22459 Hamburg, Germany

References

1. Fried LP, Tangen CM, Walston, et al.: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56A; M146–56.

2. Inouye S, Peduzzi P, Robison, et al.: Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998; 279: 1187–93.

3. Frilling B, von Renteln-Kruse W, Riess FC: Prognostic value of geriatric assessment prior to cardiac surgery of the elderly. JACC 2009; 53: A403–18.

4. Friedrich I, Simm A, Kötting J, Thölen F, Fischer B, Silber RE: Cardiac surgery in the elderly patient [Der alte Patient in der Herzchirurgie]. Dtsch Arztebl Int 2009; 106(25): 416–22.