Outcomes after Abdominal Aortic Aneurysm Repair in Those ≥80 Years of Age: Recent Veterans Affairs Experience

Abstract

During fiscal years 91-95, 6260 patients underwent 6269 abdominal aortic aneurysm (AAA) repairs in Veterans Affairs Medical Centers. Those ⩾80 years old comprised 3.7% (n = 231) of the patients. A total of 5833 patients underwent repair of nonruptured AAA: mortality was 4.1% (228/5627) in those <80 and 8.25% (17/206) in those ≥80 years old (p < 0.009). Logistic regression analysis indicated age ≥80 was independently associated with higher mortality (odds ratio 1.834:1, 95% bounds 1.117-3.012). Octogenarian status (defined as ≥80 years of age), however, had a less important association with in-hospital death than did surgical complications of the heart or genitourinary tract, postoperative hemorrhage, septicemia, respiratory insufficiency, myocardial infarction (MI), acute renal failure, surgical complications of the central nervous system (CNS), aneurysm rupture, postoperative shock, or disseminated intravascular coagulation (DIC), in ascending order of importance. Only 5.9% (n= 25) of the 427 patients undergoing repair of ruptured AAA were ≥80 years old. In those ≥80 undergoing repair of ruptured aneurysms, mortality was 48% which did not differ from the 45% mortality in those <80 (NS). The likelihood that one would be operated for rupture was statistically greater (1.66:1) for those ≥80 years (p < 0.025). Length of stay (LOS) for those ≥80 undergoing AAA repair was longer being 22.3 ± 14.8 days versus 18.3 ± 13.2 days for younger patients (p < 0.001). Mortality and LOS after AAA repair were statistically greater for those ≥80 years of age. Severity of illness, however, was also greater for octogenarians. Patient Management Category (PMC) software defined illness severity was 4.06 ± 1.22 in octogenarians versus 3.84 ± 1.13 for those younger (p < 0.005). Though age ≥80 was independently associated with increased mortality, selected elderly patients could benefit from AAA repair.