Outcomes after open repair of ruptured abdominal aortic aneurysms in octogenarians: a 20-year, single-center experience

Barakat, Hashem M.; Shahin, Yousef; Barnes, Rachel; Chetter, Ian; McCollum, Peter

Abstract

Background
The purpose of this study was to evaluate morbidity, mortality, and survival in octogenarians undergoing open repair of ruptured abdominal aortic aneurysms (RAAAs) in comparison to younger patients.MethodsThis investigation was a retrospective analysis of a prospectively maintained database from a tertiary referral center. We included all consecutive RAAA patients who underwent open repair from 1990 to 2011. Univariate and multivariate analyses were used to identify predictors of inferior short- and long-term outcomes.

Results
Overall, 463 patients were identified, of whom 138 (30%) were octogenarians (group 2), with a mean age of 84 ± 0.47 years. There were 96 (69%) men and 42 women (31%). There were more women in group 2 (31%) compared with the 0.05). Median preoperative hemoglobin (P < 0.001) and creatinine (P = 0.031) levels were significantly different between the groups. There was no significant difference between the two groups in terms of postoperative complications and length of hospital stay. Median long-term survival for octogenarians (group 2) was 5.4 years compared with 12.4 years for the younger patient group (group 1) (P < 0.001). Multivariate analysis identified age as an independent predictor of 30-day mortality (odds ratio [OR] = 1.154, 95% confidence interval [CI] 1.037-1.285) and inferior long-term survival (OR = 1.074, 95% CI 1.011-1.141). History of cigarette smoking also predicted worse long-term outcomes (OR = 3.044, 95% CI 1.318-7.032) as did multiorgan failure in the postoperative course (OR = 1.363, 95% CI 1.080-14.130).

Conclusions
Advanced age is associated with high surgical mortality; however, for octogenarians surviving surgical repair, long-term outcome is acceptable. Therefore, with responsible decision-making, surgical intervention is justifiable in the elderly. Smoking and multiorgan failure were both predictive of worse survival.

Citation

Barakat, H. M., Shahin, Y., Barnes, R., Chetter, I., & McCollum, P. (2014). Outcomes after open repair of ruptured abdominal aortic aneurysms in octogenarians: a 20-year, single-center experience. Annals of vascular surgery, 28(1), 80-86. https://doi.org/10.1016/j.avsg.2013.07.006

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2013
• Online Publication Date: Nov 5, 2013
• Publication Date: 2014-01
• Journal: Annals of Vascular Surgery
• Print ISSN: 0890-5096
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Issue: 1
• Pages: 80-86
• DOI: https://doi.org/10.1016/j.avsg.2013.07.006
• Keywords: Surgery; Cardiology and Cardiovascular Medicine; General Medicine
• Public URL: https://hull-repository.worktribe.com/output/432565
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0890509613003932?via%3Dihub