Cardiac surgery in older adults: a retrospective cohort study of outcomes and risk score performance in octogenarians versus patients aged 65–79 years

BACKGROUND: The role of cardiac surgery in octogenarians is debated, but limited data exist for patients aged 65-79. This study compared clinical characteristics, surgical procedures, and outcomes between patients ≥ 80 and those aged 65-79 years to evaluate whether age alone should influence surgical decisions. METHODS: We conducted a retrospective cohort study including all patients aged ≥ 65 who underwent cardiac surgery between January 2019 and December 2022. Patients were divided into two groups: 65-79 years (n = 217) and ≥ 80 years (n = 57). Demographic, clinical, and surgical data were collected and analyzed. EuroSCORE II and STS scores were evaluated as predictors of in-hospital mortality. RESULTS: Among 274 patients (median age 74 [IQR 69-79]), the overall in-hospital mortality rate was 11.6%, slightly higher in octogenarians, although the difference was not statistically significant (15.7% vs. 10.5%, p = 0.39). Octogenarians had significantly higher EuroSCORE II values (4.31 vs. 2.81, p < 0.005), longer cardiopulmonary bypass and aortic cross-clamp times, and a higher proportion of non-elective procedures. There were no statistically significant differences between groups in postoperative complications, including acute kidney injury, atrial fibrillation, or cardiogenic shock. EuroSCORE II demonstrated a trend toward better discriminative performance in octogenarians (AUC 0.831; 95% CI: 0.6964-0.9656) compared to patients aged 65-79 years (AUC 0.6432; 95% CI: 0.5825-0.8095), though this did not reach statistical significance (p = 0.06175). The STS score showed moderate and consistent predictive performance across age groups, with AUCs of 0.6981 in the overall cohort, 0.6971 in patients <80 years, and 0.6894 in patients ≥80 years. CONCLUSION: Patients aged ≥80 years exhibited similar in-hospital mortality rates and no increase in postoperative complication rates compared to younger elderly patients. EuroSCORE II appears to outperform the STS score in predicting in-hospital mortality among octogenarians.