S. Zarrintan1, O. Fuson1, J. Lane1, B. Clary1, M. Malas1 1University Of California – San Diego, Department Of Surgery, San Diego, CA, USA
Introduction: In an aging population with increasing prevalence of aortoiliac occlusive disease (AIOD), the management of octogenarians presents unique challenges due to higher rates of comorbidities and reduced physiological reserves. This study utilizes Vascular Quality Initiative (VQI) data to evaluate the outcomes of suprainguinal bypass in octogenarians.
Methods: Patients >50 years old undergoing suprainguinal bypass for AIOD in the VQI database (2009-2023) were included. Patients were stratified based on age category (Octogenarians vs. Non-Octogenarians). The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications, postoperative reintervention, RBC transfusion, ICU stay >3 days, and 1-year mortality. Postoperative complications included MI, respiratory complications, CHF, postoperative non-ambulatory status (NAS), and surgical site infection (SSI). Logistic and Cox regressions were used for multivariate analyses. A Poisson spline model was used to show the 30-day mortality risk across ages 51 to 89.
Results: A total of 1,397 octogenarians (7%) and 18,533 non-octogenarians (93%) were included. Octogenarians had more severe comorbidities and were more likely to present with critical limb ischemia (56.1% vs. 45.6%; P<.001). Octogenarians primarily underwent femorofemoral (FFB) (56.1%), axillofemoral (AxFB) (36.6%), and aortofemoral/aortoiliac (AFB/AIB) (7.4%) procedures, while non-octogenarians predominantly received AFB/AIB (47.8%), FFB (32.8%), and AxFB (19.4%) procedures. After adjusting for potential confounders, octogenarian category was associated with increased risk of 30-day mortality (aOR=1.99, 95%CI=1.56-2.55; P<.001), MI (aOR=1.59, 95%CI=1.18-2.14; P=.002), CHF (aOR=1.46, 95%CI=1.04-2.06; P=.028), NAS (aOR=1.56, 95%CI=1.24-1.97; P<.001), RBC transfusion (aOR=1.16, 95%CI=1.01-1.34; P=.039), and one-year mortality (aHR=2.05, 95%CI=1.78-2.36; P<.001). However, respiratory complications, SSI, ICU stay >3 days, and reintervention were not affected by age category. Our spline model demonstrated a significant association between age and the risk of 30-day mortality beginning at 59 years (Fig 1). A sub-analysis of outcomes only in the octogenarian cohort revealed that extra-anatomical bypass was associated with lower risk of 30-day mortality compared to AFB/AIB (aOR=0.47, 95%CI=0.25-0.88; P=.018).
Conclusion: Octogenarians are at higher risk of 30-day and 1-year mortality, as well as postoperative cardiac complications following suprainguinal bypass. In this population, extra-anatomic bypass is associated with a significant reduction in mortality and should be considered the first-line approach. Additionally, optimizing perioperative medical management should be strongly considered.