Outcome and survival of patients aged 75 years and older compared to younger patients after ruptured abdominal aortic aneurysm repair: do the results justify the effort?Ann Vasc Surg. 2009 Jul-Aug; 23(4):469-77.AV
We evaluated early mortality (<30 days) rates, cost analyses, and preoperative variables that may be predictive of 30-day mortality in elderly patients compared to younger patients after emergency open repair of ruptured abdominal aortic aneurysm (RAAA). The survey is a retrospective analysis based on prospectively registered data. The protocol was an "all-comers" policy. Seventy-two patients, who were operated on for RAAA in our department from January 1, 2005, to December 30, 2005, are included in this study. The follow-up time of survivors was 1 year. We defined 75-year-old patients as elderly because of the increased incidence of surgical risk factors and hospital mortality in this subset of patients (cut-off age). Demographic, clinical, and operative factors were analyzed together with 30-day mortality. Univariate analysis was performed with the chi-squared test. Multivariate analyses were also performed with the variables that were found to be significant in the univariate analysis. Health economy and cost analysis for the two groups were estimated. Out of 72 open repairs of RAAA, 44 patients (61%) were under 75 years of age and 28 (39%) were 75 years or older. The average age of the patients was 71 years (confidence interval [CI] 69.2-73.7, range 53-87). Twenty-five patients (35%, CI 27.6-51.2) died within 30 days in the postoperative period. The 30-day mortality for the 28 elderly patients who underwent open operative repair was 16 (57%, CI 48%-72%) compared to 9 (20%, CI 12%-33%) of 44 younger patients (p < 0.001). An age of 75 years or older and a serum creatinine >or=0.150 mmol/L in elderly patients with RAAA (p < 0.01) were identified to be significant risk factors for operative mortality. We did not encounter significant differences in the distribution of other risk factors in the group of elderly patients compared to the younger group. Between the survivors of the two groups, there were no significant differences in the total length of stay (LOS) and the LOS in the intensive care unit. Advanced age (>or=75) and the combination of this advanced age and serum creatinine of >or=0.150 mmol/L were the only significant (p < 0.05) preoperative risk factors in our single-center study. However, we believe that treatment for RAAA can be justified in elderly patients. In our experience, surgical open repair has been life-saving in 33% of patients aged 75 years and older, at a relatively low price for each life, estimated at euro 40,409.