Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Abstract

BackgroundIn recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients.MethodsData of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching.ResultsThe study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p = 0.61) with reference to conservative treatment.ConclusionsAll-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0814-6) contains supplementary material, which is available to authorized users.

Describing Variability of Inpatient Consultation Practices: Physician, Patient, and Admission Factors

“…Although related to medical complexity, these effects persist despite adjustment, which raises the question of whether they contribute to the decision to seek consultation. Older patients received fewer consultations, which could reflect the use of more conservative practice models in the elderly, 12 or ageism, which is associated with undertreatment. 13 With respect to insurance status, Medicaid patients were associated with fewer consultations.…”

Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

“…12 Other groups have reported acceptable rates of surgical mortality between 0% and 15.6% in octogenarians. [13][14][15] A number of studies have investigated outcomes of patients presenting with neurological deficit as a complication of TAAAD. Several analyses have shown that patients who present with CVA in the presence of TAAAD are at risk of significantly increased rates of postoperative mortality between 25.7% -40.2%.…”

Clinical Outcomes of Limited Repair And Conservative Approaches In Older Patients With Acute Type A Aortic Dissection

“…Acute type A aortic dissection remains a fatal disease despite recent improvements in surgical outcomes, and the patients experience various post-surgical complications. Based on several reports on surgical outcomes in older patients with acute type A aortic dissection, the surgical mortality rate is 3.7%-35% [2][3][4]9,10,[15][16][17][18]. TAR has higher mortality and morbidity rates than ascending or hemiarch replacement [19].…”