Key result
Intact AAA repair in octogenarians is linked to higher peri-operative mortality, reaching ~12% with OSR.
Why the study?
Mortality following aneurysm surgery is increased for octogenarians, but mortality for octogenarians with either low or high peri-operative risks remained unclear.
Does age ≥ 80 years increase peri-operative mortality and major complications in patients undergoing intact abdominal aortic aneurysm repair compared to non-octogenarians?
Cohort (n=15,869)
Yes
Does age ≥ 80 years increase peri-operative mortality and major complications in patients undergoing intact abdominal aortic aneurysm repair compared to non-octogenarians?
Octogenarians have significantly higher peri-operative mortality and major complication rates after intact AAA repair, particularly OSR, highlighting the need for careful patient selection based on comorbidities.
Answers are grounded in this paper and cite their sources.
May warrant comorbidity-guided selection for octogenarians; leaves open prospective comparisons of EVAR versus OSR.
OBJECTIVE: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. METHODS: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. RESULTS: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. CONCLUSION: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.
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Alberga et al. (2021) conducted a cohort in Intact abdominal aortic aneurysm (n=15,869). Intact abdominal aortic aneurysm repair (EVAR or OSR) in octogenarians vs. Non-octogenarians was evaluated on Peri-operative mortality. Octogenarians undergoing intact abdominal aortic aneurysm repair had significantly higher peri-operative mortality than non-octogenarians, with mortality rates of 1.9% after EVAR and 11.8% after OSR.
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