Shahidi S, Schroeder T Veith, Carstensen M, Sillesen H
Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
Ann Vasc Surg. 2009 Jul-Aug;23(4):469-77. doi: 10.1016/j.avsg.2008.10.009. Epub 2009 Jan 10.
We evaluated early mortality (<30 days) rates, cost analyses, and preoperative variables that may be predictive of 30-day mortality in elderly patients compared to younger patients after emergency open repair of ruptured abdominal aortic aneurysm (RAAA). The survey is a retrospective analysis based on prospectively registered data. The protocol was an "all-comers" policy. Seventy-two patients, who were operated on for RAAA in our department from January 1, 2005, to December 30, 2005, are included in this study. The follow-up time of survivors was 1 year. We defined 75-year-old patients as elderly because of the increased incidence of surgical risk factors and hospital mortality in this subset of patients (cut-off age). Demographic, clinical, and operative factors were analyzed together with 30-day mortality. Univariate analysis was performed with the chi-squared test. Multivariate analyses were also performed with the variables that were found to be significant in the univariate analysis. Health economy and cost analysis for the two groups were estimated. Out of 72 open repairs of RAAA, 44 patients (61%) were under 75 years of age and 28 (39%) were 75 years or older. The average age of the patients was 71 years (confidence interval [CI] 69.2-73.7, range 53-87). Twenty-five patients (35%, CI 27.6-51.2) died within 30 days in the postoperative period. The 30-day mortality for the 28 elderly patients who underwent open operative repair was 16 (57%, CI 48%-72%) compared to 9 (20%, CI 12%-33%) of 44 younger patients (p < 0.001). An age of 75 years or older and a serum creatinine >or=0.150 mmol/L in elderly patients with RAAA (p < 0.01) were identified to be significant risk factors for operative mortality. We did not encounter significant differences in the distribution of other risk factors in the group of elderly patients compared to the younger group. Between the survivors of the two groups, there were no significant differences in the total length of stay (LOS) and the LOS in the intensive care unit. Advanced age (>or=75) and the combination of this advanced age and serum creatinine of >or=0.150 mmol/L were the only significant (p < 0.05) preoperative risk factors in our single-center study. However, we believe that treatment for RAAA can be justified in elderly patients. In our experience, surgical open repair has been life-saving in 33% of patients aged 75 years and older, at a relatively low price for each life, estimated at euro 40,409.
我们评估了老年患者与年轻患者在急诊开放性修复破裂腹主动脉瘤（RAAA）后30天内的早期死亡率（<30天）、成本分析以及可能预测30天死亡率的术前变量。该调查是基于前瞻性登记数据的回顾性分析。研究方案为“所有患者皆纳入”政策。本研究纳入了2005年1月1日至2005年12月30日在我院接受RAAA手术的72例患者。幸存者的随访时间为1年。由于该年龄段患者手术风险因素和医院死亡率增加（临界年龄），我们将75岁及以上患者定义为老年患者。对人口统计学、临床和手术因素以及30天死亡率进行了分析。采用卡方检验进行单因素分析。还对在单因素分析中发现具有显著性的变量进行了多因素分析。对两组进行了卫生经济学和成本分析。在72例RAAA开放性修复患者中，44例（61%）年龄在75岁以下，28例（39%）年龄在75岁及以上。患者的平均年龄为71岁（置信区间[CI]69.2 - 73.7，范围53 - 87）。25例患者（35%，CI 27.6 - 51.2）在术后30天内死亡。28例接受开放性手术修复的老年患者的30天死亡率为16例（57%，CI 48% - 72%），而44例年轻患者为9例（20%，CI 12% - 33%）（p < 0.001）。RAAA老年患者年龄在75岁及以上以及血清肌酐≥0.150 mmol/L（p < 0.01）被确定为手术死亡率的显著危险因素。与年轻组相比，我们未发现老年患者组中其他危险因素的分布存在显著差异。两组幸存者之间，总住院时间（LOS）和重症监护病房住院时间无显著差异。在我们的单中心研究中，高龄（≥75岁）以及高龄与血清肌酐≥0.150 mmol/L的组合是仅有的显著（p < 0.
