Mortality after endovascular versus open repair of abdominal aortic aneurysm in the elderly

J Surg Res. 2017 Jul;215:153-159. doi: 10.1016/j.jss.2017.03.061. Epub 2017 Apr 7.

Abstract

Background: Age is a well-known risk factor for postoperative death in patients with abdominal aortic aneurysms (AAA), and the efficacy of open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR) remains controversial in the elderly population. The aim of this study was to determine the predictors of 30-d mortality after AAA repair in elderly population.

Methods: Using the National Surgical Quality Improvement Program vascular-targeted database (2011-2014), we identified all patients aged >70 y who underwent OAR and EVAR for nonruptured AAA. Univariate and multivariable logistic regression analyses were implemented to examine postoperative mortality adjusting for patient demographics and characteristics.

Results: A total of 4229 nonruptured AAA repairs were performed (OAR: 360 [8.5%] versus EVAR: 3869 [91.5%]). Most patients were males (79 %) and White (81%) with a mean age of 78 ± 6 y. Obesity was more prevalent in EVAR group (31% versus 24%, P = 0.008). Whereas, smoking was more likely to be seen in patients undergoing an OAR (35% versus 22%, P < 0.001). The 30-d mortality was significantly higher after OAR versus EVAR (8% versus 2%, P < 0.001). After adjusting, OAR was associated with almost five times higher mortality than EVAR (adjusted odds ratio: 4.88; 2.85-8.34, P < 0.001).

Conclusions: This study reflects contemporary real world outcomes of nonruptured AAA repair in the elderly. Open repair was associated with almost fivefold increase in mortality compared with endovascular repair. Elderly patients who are functionally dependent are less likely to benefit from AAA repair, whether OAR or EVAR. Further prospective studies are required to better understand the predictors of mortality after AAA repair in the geriatric population which could guide decision-making and improve outcomes in this population.

Keywords: Abdominal aortic aneurysm; Mortality; NSQIP; Nonruptured aneurysm; Open versus endovascular repair; Vascular surgery.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Endovascular Procedures / mortality*
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Male
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome