Outcomes of Octogenarians Receiving Aortic Repair

Abstract

Introduction: Abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5cm in men and 5cm in women. We sought to evaluate current practices of elective AAA repair and one- and two-year outcomes in octogenarians. Methods: We identified octogenarians undergoing elective AAA repair in the Vascular Quality Initiative from 2012-2019. Standard statistical methods were used. Frailty was calculated using previously published methods. Results: 21.39% of all aortic operations were performed on octogenarians; 9,735(23.34%) endovascular (EVAR) and 755(10.31%) open repair (OAR). 41.47% of EVARs were under size thresholds: 47.69% males ≤5.5cm diameter and 21.32% females ≤5.0cm diameter compared with 18.68% OARs: 23.24% males and 10.62% females. Additionally, 31.33% had high frailty scores. One- and two-year mortality was 9.33%±0.30% and 14.76%±0.39% for EVAR and 15.20%±1.34% and 18.94%±1.53% for OAR patients, respectively. Among these patients, high frailty was associated with two-year mortality (EVAR; (HR=2.78[2.35-3.30], p < 0.01) and OAR; (HR=1.86[1.27-2.72], p < 0.01)). For EVAR, other patient factors associated with mortality included heart failure (HR=1.33[1.14-1.55], p < 0.01) and dialysis (HR=1.71[1.13-2.59], p = 0.01). For OAR, history of coronary artery bypass (HR=1. 54[1.01-2.36], p = 0.047) was associated with mortality. Statin use was protective of mortality for all patients (EVAR; (HR=0.70[0.62-0.80], p < 0.01): OAR;(HR=0.60[0.40-0.90], p = 0.01)). Conclusion: Nationally, a large portion of elective AAA repair in octogenarians is performed below recommended size thresholds and a third are frail patients. High two-year mortality after AAA repair in this age group exceeds the published risk of rupture for 5-5.5 cm AAA, suggesting that increase in the size threshold of elective repair among octogenarians should be explored.