Issue link: https://maltatoday.uberflip.com/i/199842
News maltatoday, Sunday, 27 October 2013 2013 Heart surgery for over 70s: Is it worthwhile? James Debono A study by leading Maltese cardiologist Alex Manche shows 28% of local patients were aged over 70 at the time of their bypass surgery. Moreover the proportion of elderly patients is likely to continue to increase as Malta's population becomes older. Is operating on these people – despite the increased risk of complication – worthwhile, asks the cardiologist in a study published in the Malta Medical Journal. "Thirty years ago patients over 65 were likely to be refused admission to an intensive care facility because of their age, and yet 28% of local patients were over 70 at the time of their coronary bypass surgery in 2011," Manche notes in the study. According to Manche the incidence of cardiovascular disease increases with advancing age and presents a continuing health care challenge in an aging population, like Malta's. Moreover because health care services rely on "finite" resources these have to be allocated to those patients "who are more likely to benefit from treatment". Such considerations would also Albert Manche (inset): 30 years ago patients over 65 were likely to be refused admission to an intensive care facility because of their age, and yet 28% of local patients were over 70 at the time of their coronary bypass surgery in 2011 increase due to the "switch from a publicly funded to a privately funded service". But Manche's study suggests that surgical interventions on over 70 year olds' remains are worthwhile. The study shows that the mean age of people undergoing cardiac survey was 61.9 years, rising from 61 in 1995, rising to 63.3 in 2011. The annual percentage of patients over 70 increased from 18.7% in the years 1995-2001 to 26.2% between 2002 and 2001. The study reviews all individual cases of cardiac surgery undertaken by Manche between April 1995 until January 2012. The study compares the outcome of surgery for those over 70 with those of patients under the age of 70. The mortality rate for the cardiac surgery population stood at just 1.2%. While for those aged over 70 the mortality rate stood at 2.7%, for those under 70 it stood at just 0.8%. In 2006 and 2011, nobody died during a surgical operation. Cardiac complications were significantly higher among over 70 year olds as were major neurological, renal and respiratory complications and minor wound complications. Still, 58% of over 70s, compared to 76% of those under 70, experienced no post-operative complication. The average length of stay on intensive care was similar for both under and over 70 year olds. But the average HDU stay was longer for over 70 year olds. Over 70 year old patients required an additional half day of high-dependency care and an additional 0.75 days on the cardiac surgical ward. After analysing the different rates of success for the two groups, Manche concludes that "although mortality and morbidity remain significantly higher, taken in the context of the overall clinical problem, cardiac surgery has much to offer in this select and growing population".