Maxwell J G, Taylor A J, Maxwell B G, Brinker C C, Covington D L, Tinsley E
Departments of Surgery, University of North Carolina at Chapel Hill New Hanover Regional Medical Center, Wilmington, North Carolina, USA.
Ann Surg. 2000 Jun;231(6):781-8. doi: 10.1097/00000658-200006000-00001.
To determine whether the rates of death and complications of carotid endarterectomy (CE) were different in the octogenarian population than in patients younger than age 80.
The utility of CE depends on the ability of the surgeon and hospital to attain low rates of death and complications, including all subgroups of the patient population. In the past 30 years, the number of people age 85 and older has increased 274%.
Detailed chart review was carried out on all CE procedures done from 1979 through 1998. Descriptive demographic data, risk factors, surgical details, length of stay, deaths, and complications were recorded.
A total of 2,398 CEs were performed in 1,970 patients; 2,180 procedures were performed in 1,783 patients younger than 80, and 218 CEs were performed in 187 patients age 80 and older. Sixty-five percent of the octogenarians and 67% of patients younger than age 80 had neurologic symptoms. Among asymptomatic patients, 89% had stenosis of 75% or more. There were 62 strokes in the 2,180 procedures in the younger group, for a stroke rate of 2.8%, and 7 strokes in the 218 procedures in the older group, for a stroke rate of 3.2%. The death rates were 0.9% for the octogenarians and 1.4% for the younger group.
Carotid endarterectomy can be safely performed in a community hospital in patients age 80 and older. Outcomes in octogenarians were not significantly different than those of younger patients and were within the range required for CE to be considered beneficial in the prevention of stroke.
确定80岁及以上人群行颈动脉内膜切除术（CE）的死亡率和并发症发生率是否与80岁以下患者不同。
CE的效用取决于外科医生和医院实现低死亡率和并发症发生率的能力，包括患者群体的所有亚组。在过去30年中，85岁及以上的人数增加了274%。
对1979年至1998年期间进行的所有CE手术进行详细的病历审查。记录描述性人口统计学数据、危险因素、手术细节、住院时间、死亡情况和并发症。
1970例患者共进行了2398例CE手术；1783例80岁以下患者进行了2180例手术，187例80岁及以上患者进行了218例CE手术。80岁及以上患者中有65%、80岁以下患者中有67%有神经系统症状。在无症状患者中，89%有75%或更高的狭窄。年轻组2180例手术中有62例发生卒中，卒中发生率为2.8%，老年组218例手术中有7例发生卒中，卒中发生率为3.2%。80岁及以上患者的死亡率为0.9%，年轻组为1.4%。
80岁及以上患者在社区医院可以安全地进行颈动脉内膜切除术。80岁及以上患者的手术结果与年轻患者相比无显著差异，且在CE被认为对预防卒中有益所需的范围内。
