TY - JOUR
T1 - Outcomes and complications among nonagenarians undergoing cardiac surgery
T2 - A scoping review
AU - Weinberg, Laurence
AU - Ludski, Jarryd
AU - Carp, Bradly
AU - Suh, Je Min
AU - Koshy, Anoop N.
AU - Haywood, Cilla
AU - Churilov, Benjamin
AU - Lee, Dong Kyu
AU - Yii, Michael
N1 - Publisher Copyright:
© 2025 Weinberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025/9
Y1 - 2025/9
N2 - Introduction This review was aimed at understanding the scope of evidence regarding outcomes and complications in nonagenarians (90–99 years of age) undergoing open cardiac surgery. Methods The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Review Protocol guidelines. A search of three databases, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, identified articles pertaining to nonagenarians undergoing various open cardiac surgical procedures. No restrictions were applied to study design or publication date. Results From the initial 1826 articles identified, we included 28 studies from eight countries in a total of 6411 nonagenarians. The median 30-day mortality rate was 10.5% (IQR 7.2–14.6). Postoperative complication rates were reported in 20 studies (71%), and the median major complication rate was 71.4%. Respiratory, cardiac, renal, neurologic, gastrointestinal, and/or infectious complications were reported in 19%, 20%, 14%, 18%, 5%, and 9% of cases, respectively. The median length of hospital stay was 12.5 days (IQR 10.4–18.0). No studies reported unplanned readmissions to the intensive care unit or detailed patient-centered outcome measures. Conclusions Although age alone should not preclude nonagenarians from undergoing cardiac surgery, the procedure is associated with a significantly elevated risk of morbidity and a relatively high mortality rate. The review findings emphasize the need for international registry data to identify risk factors associated with adverse outcomes, explore strategies to decrease the risk of major complications, and improve postoperative quality of life. Moreover, creating and implementing uniform preoperative frailty assessments, and correlating them with surgical outcomes, will be crucial. Developing standardized patient-reported experience and outcome measures will also be imperative. Scoping review registered on OSF registries (https://osf.io/4mg7n).
AB - Introduction This review was aimed at understanding the scope of evidence regarding outcomes and complications in nonagenarians (90–99 years of age) undergoing open cardiac surgery. Methods The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Review Protocol guidelines. A search of three databases, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, identified articles pertaining to nonagenarians undergoing various open cardiac surgical procedures. No restrictions were applied to study design or publication date. Results From the initial 1826 articles identified, we included 28 studies from eight countries in a total of 6411 nonagenarians. The median 30-day mortality rate was 10.5% (IQR 7.2–14.6). Postoperative complication rates were reported in 20 studies (71%), and the median major complication rate was 71.4%. Respiratory, cardiac, renal, neurologic, gastrointestinal, and/or infectious complications were reported in 19%, 20%, 14%, 18%, 5%, and 9% of cases, respectively. The median length of hospital stay was 12.5 days (IQR 10.4–18.0). No studies reported unplanned readmissions to the intensive care unit or detailed patient-centered outcome measures. Conclusions Although age alone should not preclude nonagenarians from undergoing cardiac surgery, the procedure is associated with a significantly elevated risk of morbidity and a relatively high mortality rate. The review findings emphasize the need for international registry data to identify risk factors associated with adverse outcomes, explore strategies to decrease the risk of major complications, and improve postoperative quality of life. Moreover, creating and implementing uniform preoperative frailty assessments, and correlating them with surgical outcomes, will be crucial. Developing standardized patient-reported experience and outcome measures will also be imperative. Scoping review registered on OSF registries (https://osf.io/4mg7n).
UR - https://www.scopus.com/pages/publications/105015415612
U2 - 10.1371/journal.pone.0331755
DO - 10.1371/journal.pone.0331755
M3 - Article
C2 - 40920802
AN - SCOPUS:105015415612
SN - 1932-6203
VL - 20
JO - PLoS ONE
JF - PLoS ONE
IS - 9 September
M1 - e0331755
ER -