Outcomes after Abdominal Aortic Aneurysm Repair in Those ≥80 Years of Age: Recent Veterans Affairs Experience

Abstract

During fiscal years 91-95, 6260 patients underwent 6269 abdominal aortic aneurysm (AAA) repairs in Veterans Affairs Medical Centers. Those > or =80 years old comprised 3.7% (n = 231) of the patients. A total of 5833 patients underwent repair of nonruptured AAA: mortality was 4.1% (228/5627) in those <80 and 8.25% (17/206) in those > or =80 years old (p < 0.009). Logistic regression analysis indicated age > or =80 was independently associated with higher mortality (odds ratio 1.834:1, 95% bounds 1.117-3.012). Octogenarian status (defined as > or =80 years of age), however, had a less important association with in-hospital death than did surgical complications of the heart or genitourinary tract, postoperative hemorrhage, septicemia, respiratory insufficiency, myocardial infarction (MI), acute renal failure, surgical complications of the central nervous system (CNS), aneurysm rupture, postoperative shock, or disseminated intravascular coagulation (DIC), in ascending order of importance. Only 5.9% (n = 25) of the 427 patients undergoing repair of ruptured AAA were > or =80 years old. In those > or =80 undergoing repair of ruptured aneurysms, mortality was 48% which did not differ from the 45% mortality in those <80 (NS). The likelihood that one would be operated for rupture was statistically greater (1.66:1) for those > or =80 years (p < 0.025). Length of stay (LOS) for those > or =80 undergoing AAA repair was longer being 22.3 +/- 14.8 days versus 18.3 +/- 13.2 days for younger patients (p < 0.001). Mortality and LOS after AAA repair were statistically greater for those > or =80 years of age. Severity of illness, however, was also greater for octogenarians. Patient Management Category (PMC) software defined illness severity was 4.06 +/- 1.22 in octogenarians versus 3.84 +/- 1.13 for those younger (p < 0.005). Though age > or =80 was independently associated with increased mortality, selected elderly patients could benefit from AAA repair.

Indicators of Survival after Open Repair of Ruptured Abdominal Aortic Aneurysms and an Index for Predicting Aneurysmal Rupture Potential

“…Rather than using predictive variables to identify patients who will not survive, several studies, including this study, have been conducted to determine the surgical tactics and anesthesiological procedures that can improve the survival rate and identify patients in whom preoperative conditions and other clinical factors make conventional surgical repair inopportune. Although several authors noted higher mortality rates among elderly patients, 6,25,28,29) advanced age was not found to be a significant predictor of survival in this study. Once elderly patients have survived the operation, they can enjoy a long life expectancy, similar to their contemporaries in the general population.…”

“…Once elderly patients have survived the operation, they can enjoy a long life expectancy, similar to their contemporaries in the general population. 28,29) Thus, it is reasonable to consider that physiologic age is more relevant than chronological age even if older patients are exposed to increased surgical risk in the case of aneurysmal rupture. Of the 43 patients who underwent open RAAA repair in this study, 35 (81.4%) survived surgery.…”

Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos

“…La mortalidad asociada a la cirugía por AAA ha disminuido drásticamente en las últimas décadas por el progreso continuo en el diagnóstico, manejo de las patologías asociadas, técnica operatoria y anestesia [3][4][5][6] . Sin embargo, la mortalidad persiste elevada en grupos específicos, particularmente en los pacientes de mayor edad [3][4][5][6][7][8][9][10] El tipo de reconstrucción y procedimientos asociados se exponen en la Tabla 2. La mortalidad global de la serie (operaciones electivas y urgentes) fue 15% (12 pacientes).…”

“…La cirugía electiva en poblaciones no seleccionadas, tiene una mortalidad que varía entre 0,72% y 5,0% en centros especializados [5][6][7] , mientras que en la cirugía de urgencia la mortalidad operatoria reportada alcanza entre 24% y 90% 4,10,12 , variando según si se trata de centros de referencia, hospitales generales o análi-sis poblacional. La edad es considerada habitualmente un factor de riesgo importante en todas las experiencias comunicadas, por lo que hay quienes estiman que la cirugía estaría contraindicada en octogenarios.…”

“…Sin embargo, hay suficiente evidencia de que la morbimortalidad depende en parte de factores predecibles, modificables o controlables [3][4][5][6]8 . Los resultados mostrados en la presente serie son comparables con los publicados en series similares, y están dentro de los estándares internacionales para la cirugía del AAA en poblaciones no seleccionadas 7,9,10 .…”