Repair of Ruptured Abdominal Aortic Aneurysm in Octogenarians

Abstract

Objective To determine whether advanced age was independently associated with prohibitive surgical risks or impaired long-term prognosis after ruptured aortic aneurysm repair. Design Post-hoc analysis of prospective cohort. Materials Consecutive patients undergoing ruptured aneurysm repair between January 2001 and December 2010 at a tertiary referral centre. Methods Surgical mortality (i.e., <30 days) was compared between octogenarians and younger patients using logistic regression modelling to adjust for suspected confounders and to identify prognostic factors. Long-term survival was compared with matched national populations. Results Sixty of 248 involved patients were octogenarians (24%) and almost all were offered open repair ( n = 237). Surgical mortality of octogenarians was 26.7% (adjusted odds ratio (OR) 2.1; 95% confidence interval (CI), 0.9–5.2) and confounded by cardiac disease. Hypovolaemic shock predicted perioperative death of octogenarians best (OR 5.1; 95%CI, 1.1–23.4; P = 0.037). After successful repair, annual mortality of octogenarians averaged 13.7% vs. 5.2% for younger patients. At 2 years, octogenarian survival was at 94% of the expected ‘normal’ survival in the general population (vs. 96% for younger patients). Conclusions Surgical mortality of ruptured aneurysm repair was not independently related to advanced age but mainly driven by cardiac disease and manifest hypovolaemic shock. An almost normal long-term prognosis of aged patients after successful repair justifies even attempts of open repair, particularly in carefully selected patients.