Locham Satinderjit, Lee Rachel, Nejim Besma, Dakour Aridi Hanaa, Malas Mahmoud
Division of Vascular and Endovascular Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
Division of Vascular and Endovascular Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
J Surg Res. 2017 Jul;215:153-159. doi: 10.1016/j.jss.2017.03.061. Epub 2017 Apr 7.
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.
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.
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).
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.
年龄是腹主动脉瘤（AAA）患者术后死亡的一个众所周知的风险因素，在老年人群中，开放动脉瘤修复术（OAR）和血管内动脉瘤修复术（EVAR）的疗效仍存在争议。本研究的目的是确定老年人群AAA修复术后30天死亡率的预测因素。
利用国家外科质量改进计划血管靶向数据库（2011 - 2014年），我们确定了所有年龄>70岁、因非破裂性AAA接受OAR和EVAR的患者。进行单因素和多因素逻辑回归分析，以调整患者人口统计学和特征来检验术后死亡率。
共进行了4229例非破裂性AAA修复术（OAR：360例[8.5%]，EVAR：3869例[91.5%]）。大多数患者为男性（79%）和白人（81%），平均年龄为78±6岁。肥胖在EVAR组更为普遍（31%对24%，P = 0.008）。然而，吸烟在接受OAR的患者中更常见（35%对22%，P < 0.001）。OAR术后30天死亡率显著高于EVAR（8%对2%，P < 0.001）。调整后，OAR的死亡率几乎是EVAR的五倍（调整后的优势比：4.88；2.85 - 8.34，P < 0.001）。
本研究反映了老年非破裂性AAA修复术的当代真实世界结果。与血管内修复相比，开放修复的死亡率几乎增加了五倍。功能依赖的老年患者从AAA修复中获益的可能性较小，无论是OAR还是EVAR。需要进一步的前瞻性研究来更好地了解老年人群AAA修复术后死亡率的预测因素，这可以指导决策并改善该人群的治疗结果。
