S. J. Aitken1,2,3, V. J. Naganathan1,3, F. Blyth1,3 1University Of Sydney,Concord Clinical School,Sydney, NSW, Australia 2Royal Australasian College Of Surgeons,Adelaide, South Australia, Australia 3Concord Repatriation General Hospital,Concord Institute Of Academic Surgery,Sydney, NSW, Australia
Introduction:
Australian data on clinical outcomes and trends in vascular surgical procedures is limited and the precise impact of age on the results of surgery remain unclear. There is little data on procedure type and volume, patient age and characteristics and surgical outcomes. Large population based clinical trials and registries are infrequent and often exclude older patients. This study is the first to use an Australian government administrative dataset to examine the epidemiology of vascular surgery outcomes in the largest state of Australia, New South Wales (NSW). The aims of this study were to determine the impact of advancing age on the number and type of vascular surgical operations performed; the characteristics of patients having these procedures; the risk of subsequent hospital admissions; and mortality over a three year period.
Methods:
Using data-linkage methods, hospital admission records of all patients undergoing vascular surgical procedures in both public and private hospitals in over the period of 2010-2012 were linked to statewide mortality records until February 2015. Vascular procedures were defined by ACHI codes based on ICD-10AM methods and included both minor and major vascular surgical procedures. Preliminary descriptive statistics were conducted prior to more detailed survival analyses with Kaplan-Meier analysis.
Results:
985,560 surgical procedures were performed between Jan 2010-Dec 2012 on 95,340 patients, resulting in 1,550,560 individual hospital episodes of care. The median age of patients having vascular surgery was 68 years old (interquartile range 20 years). 42% of patients were female. Mean length of stay was 2.8 days. Patients aged 75 years and older had a significantly longer length of stay than younger patients (mean difference 0.9 days, P<.0001) and required more reoperations (11 additional procedures, P<.0001). 14,720 patients died during the study period. All cause mortality for the cohort was 15% within the follow up period, with median survival 278 days after surgery (interquartile range 381 days). Patients who died were older (mean difference 8.7 years, P<.0001) and more likely to be female (P<.0001) compared to those who survived, and had a higher average number of subsequent hospital admissions than patients who did not die during the study period (27 vs 13 hospital admissions respectively).
Conclusion:
Increasing age is associated with adverse outcomes after vascular surgery in NSW, Australia, including longer length of stay, high rates of surgical reintervention and decreased survival. Greater understanding of the factors contributing to poor outcomes in older patients is required for planning quality improvement initiatives. Data-linkage provides opportunity for further analysis into factors influencing vascular surgical outcomes such as the role of increasing age, frailty and comorbidities, the impact of regionalization and center volume, and outcomes emerging endovascular techniques.