Too Old for a Bypass?
No. So why are the elderly turned down for heart surgery?
A Bypass Believer
Such success stories are the norm for Carlsen's surgeon, Jack Sternlieb, MD, president and founder of The Heart Hospital. "I feel confident in operating on these people," says Sternlieb, who practices in a retirement mecca with a large elderly population. "This operation shouldn't kill you. That's the point."
The average age of his patients who come in for bypass, he says, is 74. Despite the potential risk, Sternlieb says chronological age alone should not be a deciding factor. "Age is not a criterion." (In keeping with his policy, the boyish-looking doctor doesn't reveal his own).
Instead of focusing on age, Sternlieb looks at psychological and social factors: "Does the patient really want to live? Do they have a good appetite? Do they have a support system? At this age, you can't just operate on them and abandon them," he says.
Getting Good Outcomes
Sternlieb is unimpressed with mortality rates reported in the Duke study, saying the numbers are still too high. "If I had mortality rates that high, I'd quit," he says. "It's possible to do this procedure much more safely."
In a recent study by Healthgrades.com, an independent online rating service, Sternlieb's hospital had the lowest in-hospital heart surgery mortality rate in the country, based on 1998 Medicare data. (In-hospital mortality rates include the number of patients who died after the surgery while still in the hospital.) While Alexander of Duke University cites a nearly 20% in-hospital mortality for elderly patients who had combined bypass and valve surgery, Sternlieb's rating for both bypass as well as the combined procedure was zero deaths -- the only cardiac program in the country to make such a claim.
Mortality data is gathered by the Health Care Financing Administration, which administers Medicare. Various organizations then analyze and distribute the findings.
The low mortality rates at The Heart Hospital, Sternlieb says, are not just due to careful selection of patients but also to the unique design of the facility -- one of the few hospitals in the country devoted solely to heart surgery. The posh 12-bed facility is set up to allow instant life-saving interventions and round-the-clock monitoring. Even when off-duty, Sternlieb keeps an eye on his patients' hearts from remote monitors set up in his nearby home. The doctor sometimes even spends the night in a patient's room. (And, it's generally acknowledged that patients who have had access to lifelong quality medical care have better odds of success, too.)
While he has shown it's possible to perform heart surgeries safely on older patients, Sternlieb cautions that there is still a risk, and that the risk can be unacceptably high in many facilities.
(Consumers can check out a facility in advance. The Healthgrades site, for instance, has an eight-page report on how to select a hospital. The Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org) grades hospitals nationwide.)
The decision to do bypass surgery must always be decided on an individual basis, Sternlieb says. "An 80-year-old doesn't have the reserves of a younger patient and can't afford as many complications," he says. Elderly women, especially, can be at high risk due to their smaller arteries and increased frailty.