Perioperative and Long-Term Morbidity and Mortality for Elderly Patients Undergoing Thoracic Aortic Surgery

Abstract

The impact of age on outcome in elective thoracic aortic surgery is not well characterized. We aim to evaluate age-related differences in short- and long-term outcomes in elderly patients undergoing elective thoracic aortic surgery. From 2004 to 2018, 786 patients underwent elective thoracic aortic surgery at a single center and were divided into 2 groups; <75 years old (n = 651) and ≥75 years old (n = 135). Outcomes include in-hospital mortality, morbidity, and long-term survival. Median follow-up was 4.8 years. Multivariable logistic regression was used to identify independent predictors of mortality and morbidity; Kaplan-Meier curves were plotted for late survival. Similar analysis was performed to the propensity-matched cohort. The elderly cohort had higher in-hospital mortality (8.2% vs 1.7%; P < 0.01), stroke (11.9 vs 2.8%; P< 0.01) and prolonged ventilation (17.3% vs 8.3%; P < 0.01), and intensive care unit stay (5.6 ± 10.9 vs 2.9 ± 6.0 days; P < 0.01). After adjusting for baseline differences and surgical complexity, age ≥75 years remained a significant predictor of hospital mortality (odds ratio [95% confidence interval]: 3.7 [1.3-10.3]). Eight-year survival was 75.4 ± 7.7% in the older group compared to 93.3 ± 1.9% in the younger group (hazard ratio [95% confidence interval]: 4.2 [1.7-11.0]). Propensity score-matched analysis also confirmed worse early- and long-term outcomes in the elderly group. Elderly patients experience higher in-hospital mortality and morbidity following elective thoracic aortic surgery compared to their younger counterparts and have a higher burden of mortality over long-term follow-up.