Carotid Endarterectomy In Octogenarians: Is It Worth The Effort?

Abstract

96 Objective. Safety, effectiveness and cost issues of carotid endarterectomy (CEA) in the elderly patient have been debated because of limited life expectancy and presumably increased complications. We compared characteristics of two populations who underwent CEA: 80 or older (older group) and 65–79 year old patients (younger group). Methods. Medical and financial data were obtained by retrospective review of hospital charts and billing records. Recent follow-up was accomplished by telephone interview. Life-table and Chi-square tests were used for statistical analysis. We analyzed 109 CEAs performed in 101 older patients from 2/1/90 to 8/30/97 and 125 CEAs performed in 121 younger patients. Results. Comparing the older with younger groups, there were no differences in gender (50% male vs 59%), incidence of preop CVA (22% vs 17%) history of TIA (23% vs 25%), amaurosis fugax (6% vs 8%), hypertension (62% vs 60%), combined perioperative death and stroke rate (1.8% vs 1.7%) or other complications (11% vs 10%). Significant differences (p<0.05) were noted between older and younger groups in incidence of diabetes (17% in the older group vs 30%) , smoking (39% vs57%) and heart disease (48% vs 28%). Length of stay (2.8 in older group vs 3.0 days) or hospital cost including readmission for treatment of complications ($9,400 in older vs $7,842) were similar. Survival rates were not significantly different at the end of three years of follow up. Conclusions. Carotid endarterectomy can be performed in the elderly as safely and cost effectively as in the younger population.