Key result
Open repair of ruptured abdominal aortic aneurysm in patients >80 years old was associated with higher immediate postoperative mortality than in younger patients (RR 1.440; 95% CI 1.365-1.519; P=0.002).
Why the study?
Does open repair of ruptured abdominal aortic aneurysm have acceptable mortality rates in patients >80 years old compared to younger patients?
Meta-Analysis
Does open repair of ruptured abdominal aortic aneurysm have acceptable mortality rates in patients >80 years old compared to younger patients?
Relative Risk: 1.44 (95% CI 1.365–1.519)
p-value: p=0.002
Open repair of ruptured abdominal aortic aneurysm in patients >80 years old carries a high but acceptable immediate mortality rate of 59.2%, with reasonable intermediate survival among operative survivors.
BACKGROUND: The role of open repair in the management of ruptured abdominal aortic aneurysm (RAAA) in patients>80 years old is questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies. METHODS: Studies on open repair of RAAA in patients>80 years old were identified in July 2010. The immediate and intermediate results were expressed as pooled proportions with 95% confidence interval (95% CI). Linear regression and meta-regression were performed to evaluate the impact of variables on the immediate postoperative mortality. RESULTS: Pooled analysis of 29 studies showed that the risk of immediate postoperative mortality in patients>80 years old was significantly higher than in younger patients (risk ratio 1.440, 95%CI 1.365-1.519, I2 36.8%, P=0.002; risk difference 19.4%, 95% CI 16.4-22.4%, I2 38.8%, P=0.019). Pooled analysis of 36 studies showed an immediate postoperative mortality rate of 59.2% (95% CI 55.7-62.5, I2 35.62). Immediate postoperative mortality in patients<80 years old positively correlated with that of patients>80 years old (rho: 0.686, P<0.0001). Intermediate survival data of 111 operative survivors were available from six studies, and their pooled survival rates at 1-, 2-, and 3-year were 82.4, 75.6, and 68.7%, respectively. CONCLUSIONS: Immediate and intermediate survival rates of patients>80 years old after open repair of RAAA are acceptable. These findings suggest a more confident approach toward emergency repair of RAAA in the very elderly.
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Biancari et al. (2011) conducted a meta-analysis in Ruptured abdominal aortic aneurysm. Open repair vs. Younger patients (<80 years old) was evaluated on Immediate postoperative mortality (RR 1.440, 95% CI 1.365-1.519, p=0.002). Open repair of ruptured abdominal aortic aneurysm in patients >80 years old was associated with higher immediate postoperative mortality than in younger patients (RR 1.440; 95% CI 1.365-1.519; P=0.002).
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