F Biancari1, M Venermo. 1. Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
Abstract
BACKGROUND: Open repair of ruptured abdominal aortic aneurysm (RAAA) in patients aged 80 years and older may be questioned owing to the patients' high operative risk and short life expectancy. METHODS: Data on patients aged at least 80 years, admitted for RAAA at four Finnish university hospitals, were collected and analysed retrospectively. RESULTS: Three hundred and ten consecutive patients aged 80 years and older with RAAA reached hospital alive; 200 (64·5 per cent) underwent open repair. The number of open repairs increased during the last 5 years (49·0 per cent of the whole series), with no significant increase in the number of patients treated conservatively. The overall in-hospital mortality rate was 72·9 per cent. The operative mortality rate was 59·0 per cent and decreased from 66 to 52 per cent during the last 5 years (P = 0·050). On multivariable analysis, shock was the only independent predictor of immediate postoperative death (odds ratio 4·97, 95 per cent confidence interval 2·09 to7·94; P < 0·001). Classification and regression tree analysis showed that preoperative haemoglobin level and presence of shock were predictive of immediate postoperative death; 19 (95 per cent) of 20 patients with shock and a haemoglobin level below 68 g/l died immediately after surgery. Among the 82 survivors of surgery, survival rates at 1, 3 and 5 years were 90, 68 and 45 per cent respectively. These values were not significantly different from those of the age-, sex- and year-matched general population (P = 0·885). CONCLUSION: Survival after open repair of RAAA among patients aged 80 years and older is sufficient to justify the procedure, particularly in patients in a stable haemodynamic condition.
BACKGROUND: Open repair of ruptured abdominal aortic aneurysm (RAAA) in patients aged 80 years and older may be questioned owing to the patients' high operative risk and short life expectancy. METHODS: Data on patients aged at least 80 years, admitted for RAAA at four Finnish university hospitals, were collected and analysed retrospectively. RESULTS: Three hundred and ten consecutive patients aged 80 years and older with RAAA reached hospital alive; 200 (64·5 per cent) underwent open repair. The number of open repairs increased during the last 5 years (49·0 per cent of the whole series), with no significant increase in the number of patients treated conservatively. The overall in-hospital mortality rate was 72·9 per cent. The operative mortality rate was 59·0 per cent and decreased from 66 to 52 per cent during the last 5 years (P = 0·050). On multivariable analysis, shock was the only independent predictor of immediate postoperative death (odds ratio 4·97, 95 per cent confidence interval 2·09 to7·94; P < 0·001). Classification and regression tree analysis showed that preoperative haemoglobin level and presence of shock were predictive of immediate postoperative death; 19 (95 per cent) of 20 patients with shock and a haemoglobin level below 68 g/l died immediately after surgery. Among the 82 survivors of surgery, survival rates at 1, 3 and 5 years were 90, 68 and 45 per cent respectively. These values were not significantly different from those of the age-, sex- and year-matched general population (P = 0·885). CONCLUSION: Survival after open repair of RAAA among patients aged 80 years and older is sufficient to justify the procedure, particularly in patients in a stable haemodynamic condition.
Authors: Jelle W Raats; Hans C Flu; Gwan H Ho; Eelco J Veen; Louwerens D Vos; Ewout W Steyerberg; Lijckle van der Laan Journal: Clin Interv Aging Date: 2014-10-13 Impact factor: 4.458