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* BACKGROUND Although health-related quality of life is diminished among patients with chronic heart failure, few investigators have examined interactions of age and sex with health-related quality of life longitudinally. [...]

Objectives. The purpose of this study was to compare lumbar spine surgical procedures by age, gender, and number of comorbidities with respect to mortality in patients 65 years of age and older in the United States. Methods. A 100% sample of the 1986 Medicare inpatient Health Care Financing Administration claims files databases involving lumbar spine surgical procedures was analyzed. Results. Lumbar spine surgery in 34 418 patients (median age = 71 years) was associated with a significant increase in in-hospital and 1 -year cumulative mortality only beyond 80 years of age. When adjusted for age, in-hospital and 1-year cumulative mortality with both decompression and excision procedures were significantly higher in men than in women. When adjusted for both age and gender, mortality increased significantly as the number of comorbidities increased. Conclusions. With lumbar spine surgery in elderly patients, mortality did not significantly increase until 80 years of age and was consistently associated with decompression and excision, with male gender, and with an increase in number of comorbidities. (Am J Public Health, 1994;84: 1292-1298), Lumbar spine surgery in elderly patients may not be associated with increased mortality until 80 years of age. In a study of Medicare patients who had lumbar spine surgery in 1986, mortality was associated with decompression and excision procedures, male gender, and an increase in number of concurrent disorders. The lowest age-adjusted one-year mortality was 2.3% for women who had fusion and fusion combination procedures, and the highest was 4.9% for men with decompression procedures. Mortality for the 80- to 85-year age range may be higher than among younger elderly patients, however, functional rather than chronological age should be considered before surgery is ruled out. It is suggested that patient selection rather than chronological age may be more important when considering patient outcome for a surgical procedure.

ABSTRACT: Randomized clinical trials of cardiac rehabilitation following myocardial infarction have typically demonstrated a lower mortality in treated patients, but with a statistically significant reduction in only one trial. To overcome the problem of not being able to detect small but clinically important benefits in mortality in randomized clinical trials of exercise and risk factor rehabilitation after myocardial infarction with small numbers of patients, we carried out a meta-analysis on the combined results of ten randomized clinical trials that included 4347 patients (control, 2145 patients; rehabilitation, 2202 patients). The pooled odds ratios of 0.76 (95% confidence intervals, 0.63 to 0.92) for all-cause death and of 0.75 (95% confidence intervals, 0.62 to 0.93) for cardiovascular death were significantly lower in the rehabilitation group than in the control group, with no significant difference for nonfatal recurrent myocardial infarction. These results suggest that, for appropriately selected patients, comprehensive cardiac rehabilitation has a beneficial effect on mortality but not on nonfatal recurrent myocardial infarction.