Predictors of early operative mortality and long-term survival in octogenarians undergoing open and endovascular repair of abdominal aortic aneurysm

Abstract

The study aims to report outcomes of open repair (OR) and endovascular aneurysm repair (EVAR) in octogenarians. Consecutive patients aged between 80 and 89 who underwent OR or EVAR were identified from a prospectively collected departmental database. Short-term outcomes included 30 days mortalities and perioperative complications; long-term outcomes included overall survival and re-intervention using the Kaplan-Meier method. Logistic regression was used to identify predictors for operative mortality and Cox regression analysis was used to identify predictors for long-term survival. From January 1999 to December 2013, 53 underwent open repairs (23 emergency and 30 elective) and 115 underwent endovascular repairs (11 emergency and 104 elective). For elective procedures, 30 days operative mortalities were 6.7% and 0% in OR and EVAR respectively (Chi square test, p=0.049). For emergency procedures, 30 days mortalities were 39.1% and 27.2% respectively (Chi square test, p=0.705). Overall 5 years survival rates were 40.4% and 36.7% after OR and EVAR respectively. Rupture of aneurysm (Odd ratio 18.8, 95% CI 3.4-104.5, p=0.001) was the only predictor for 30 days mortality. Rupture of aneurysm (Hazard ratio 2.0, 95% CI 1.3-3.3, p=0.003), history of lung disease (Hazard ratio 1.7, 95% CI 1.0-2.9, p=0.039) and history of renal disease (Hazard ratio 2.1, 95% CI 1.4-3.1, p<0.001) were independent predictors for long-term overall survival. Decision of AAA repair in octogenarians should not be based on age alone. Both elective OR and EVAR had acceptable perioperative risk, but emergency repair, lung disease and renal impairment predicted poor long-term survival.