C. W. Hicks1, T. Obeid1, S. Locham1, M. A. Cooper1, I. Arhuidese1, M. B. Malas1 1Johns Hopkins University School Of Medicine,Division Of Vascular Surgery And Endovascular Therapy,Baltimore, MD, USA
Introduction: Among older patients, both open aortic aneurysm repair (OAR) and endovascular aortic aneurysm repair (EVAR) are associated with higher risk of death compared to the general population. We aim to describe trends in failure to rescue (FTR) among octogenarians undergoing OAR and EVAR to identify patients at high risk for mortality following elective AAA repair.
Methods: All octogenarians (age ≥80 years) recorded in the Vascular Quality Initiative database (2002-2014) who underwent non-ruptured infrarenal AAA repair were included. Primary outcome was FTR, defined as percentage of deaths in patients who had a complication within 30 days of surgery. Univariable and multivariable statistics were used to identify risk factors for FTR following OAR and EVAR procedures.
Results: 975 octogenarians underwent AAA repair during the study period (EVAR=667, OAR=308). Mean age was 84±2.8 years, 69% were male, and 59% had multiple (≥2) comorbidities. Overall FTR was 10%, most commonly related to acute kidney injury (62%) and respiratory failure (53%). On multivariable analysis correcting for baseline group differences, independent predictors of FTR included female gender (OR 1.95), the presence of multiple comorbidities (OR 1.98), baseline renal insufficiency (OR 1.97), peripheral vascular disease (OR 2.42), and perioperative vasopressor use (OR 4.49) (all, P<0.02). Obesity was protective (OR 0.58, P=0.02). FTR was higher following OAR vs. EVAR on univariable analysis (14% vs. 9%; P=0.02), but there was no significant difference between operative approaches after risk adjustment (OR 1.15, P=0.60). Comparing octogenarians vs. younger patients (N=2,854), FTR was significantly higher for octogenarians for both OAR (OR 2.0, 95% CI 1.36-3.01) and EVAR (OR 1.60, 95% CI 1.07-2.40) after risk adjustment.
Conclusion: Failure to rescue after AAA repair is not uncommon among octogenarians and could explain the higher mortality observed in this group compared to the general population. Female gender, renal insufficiency, concomitant peripheral arterial disease, and frailty, including the presence of multiple comorbidities and poor nutritional status, appear to be the major predictors of adverse outcomes. Overall health status should be carefully considered when weighing the risks versus benefits of performing AAA repair in elderly patients.