Age-stratified outcomes in elderly patients undergoing open and endovascular procedures for aortoiliac occlusive disease

Abstract

Background: The elderly comprise a sizeable segment of patients with aortoiliac occlusive disease (AIOD). We analyzed outcomes in elderly patients who underwent open and endovascular procedures for AIOD.

Methods: Elderly patients with AIOD who underwent open and endovascular procedures in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2007 were identified. Patients were stratified into age groups: 65-69 years, 70-79 years, and 80 years or older. The clinical outcomes were complications and mortality; the economic outcomes were duration of stay and hospital cost. Both open and endovascular procedures were compared using chi(2) analysis, analysis of variance (ANOVA), and multivariate linear and logistic regression.

Results: Patients aged 80 years or older were more likely be nonelective admissions (43%), have a high Charlson Comorbidity Index (12%), and have iliac artery disease (63%, all P < .05). Patients aged 80 years or older who underwent open procedures had higher complication and mortality rates compared with younger patients (both P < .05). Endovascular procedures had a lower complication rate, duration of stay, and hospital cost for all age groups (P < .05). Mortality was significantly lower for endovascular treatment in patients aged 70 years or older (P < .05). A multivariate analysis showed patients aged 70 years or older were at increased risk of complications (P < .05).

Conclusion: For both procedures, clinical outcomes worsen as patient age increases. In patients aged 70 years or older, endovascular treatment conferred a lower complication rate than open repair.