MARCH 21, 1994 VOLUME 1, NUMBER 18
Coronary bypass surgery is increasingly common among the elderly. In fact, many hospitals report that between 10% and 25% of coronary bypass patients are over 80.
Until recently, little research had been conducted into the success rates of heart surgery in older patients. Now, Dr. Paul Stelzer of New York’s Lenox Hill Hospital has reported on a study following 168 elderly patients after heart surgery. Dr. Stelzer’s results indicate that such patients do well, provided that they were in reasonably good health before the surgery.
According to Dr. Stelzer’s report, nearly 6% of patients died immediately after surgery, which is double the death rate in younger patients. The risk of other complications, including stroke, sepsis and kidney failure, was also roughly twice the similar risk in younger patients. Still, the risk of death or serious complications was low enough that the benefits of surgery outweighed those risks.
About his elderly subjects, Dr. Stelzer says “they deserve a chance, unless they’ve got some big strikes against them.” He indicates that elderly patients with weak left ventricles or a history of strokes or kidney disease may not be good candidates for the surgery. He also says the elderly heart patient must have a strong will to survive.
Living Wills Cut Patient Care Costs
Another recently released study shows what many already knew intuitively. Costs of caring for patients during the end-of-life period are significantly lower when the patient has executed an advance directive.
According to the study, published in the March issue of Archives of Internal Medicine, Medicare patients with advance directives cost a little more than one-third of the amount spent on patients without directives during the end-of-life treatment period. For the 342 patients without directives studied, the average cost of the final hospital stay was $95,305. For the 132 patients with directives, the comparable figure was $30,478.
The study’s director, Dr. Christopher V. Chambers, of Thomas Jefferson University in Philadelphia, says that the study “shows that respecting a patient’s right to choose the kind of medical care received at the end of life also results in a tremendous benefit to society by limiting resources spent on futile and often unwanted attempts to prolong life.” The study also inadvertently reveals how few patients have executed advance directives.
Q & A
Q: In an answer you gave two weeks ago about the care of a terminally ill woman, you completely failed to mention the support and services available from an accredited hospice program. What’s wrong with you, anyway?
(Ed. note–OK, I changed the question a little bit)
A: You are right. The earlier question did not really address the kind of care to be administered to the patient, but asked about the need to fully inform the patient of her terminal condition. I should have mentioned that, in addition to being expert at dealing with end-of-life care, hospice providers are also experts at the social, psychological and emotional issues associated with patient care and family dynamics. A consultation with a hospice provider might have been the best possible suggestion.