L. A. Huntress3, J. Kalenik2, V. Dombrovskiy3, S. G. Huang3, R. Shafritz3, S. Rahimi3 2University of Georgia,Athens, GA, USA 3Rutgers RWJMS,Division Of Vascular Surgery,New Brunswick, NJ, USA
Introduction: The practicality of non-ruptured abdominal aortic aneurysm (AAA) repair in patients aged 90 and above (90+) remains in question. This study assessed the short-term outcomes of elective endovascular aortic repair (EVAR), and compared them between patients aged 90+ and patients aged 80-89.
Methods: The National Inpatient Sample (NIS) was queried from 2012-2015, and patients aged 80 and above who had undergone elective EVAR were identified. Postoperative complications, hospital mortality, hospital length of stay, and total hospital cost in patients aged 90+ were compared to those aged 80-89 using Chi square test; multivariable logistic regression analysis controlled for age, gender, race, comorbidities, and hospital characteristics; and Wilcoxon rank sum test. Total hospital cost was adjusted to 2015 U.S. dollars.
Results: A total of 26,115 patients were estimated: 24,210 (92.7%) aged 80-89 and 1,905 (7.3%) aged 90+. Compared to octogenarians, patients aged 90+ were more likely to develop postoperative cardiac complications (OR [odds ratio]=1.68; 95%CI [confidence interval] 1.29-2.18), stroke (OR=3.19; 95%CI 1.59-6.39), urinary tract infection (OR=1.39; 95%CI 1.06-1.82), and bleeding (OR=1.41; 95%CI 1.23-1.62), the last of which required more blood transfusions (OR=1.31; 95%CI 1.14-1.52). However, hospital mortality did not differ among both age groups, and no differences in mortality among various races or genders were observed. At the same time, mortality overall in urban teaching and non-teaching hospitals was lower than in rural hospitals (OR=0.37; 95%CI 0.22-0.62 and OR=0.43; 95%CI 0.25-0.74, respectively). Hospital length of stay (median= 2 days, IQR [interquartile range] 1-3 days in both groups) and total hospital cost (median= $27,950; IQR $21,193-36,079 in octogenarians vs median= $27,203; IQR $20,436-36,332 in nonagenarians; P=0.47) did not differ between the two age groups
Conclusion: Although patients aged 90+ are at an increased risk of some postoperative complications following elective EVAR, hospital mortality and hospital resource utilization in this group of patients are not greater than in octogenarians. Elective EVAR should be considered in nonagenarians with non-ruptured abdominal aortic aneurysm.