Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Vascular. 2024 Feb;32(1):84-90. doi: 10.1177/17085381221125953. Epub 2022 Sep 5.
Open lower extremity revascularization is controversial among octogenarians; however, the indications for surgical bypass are higher in the elderly population. The aim of the study was to compare postoperative outcomes between octogenarians and non-octogenarians following femoropopliteal bypass surgery.
Our regional, multi-institutional database was queried for femoropopliteal bypass procedures performed between 1995 and 2020. Electronic medical records were individually reviewed for operative and postoperative data. Univariable and multivariable logistic regression were utilized to determine predictors of postoperative outcomes.
Among 1315 patients who underwent femoropopliteal bypass, 234 (17.8%) were octogenarians. Octogenarians more frequently underwent bypass for lower extremity tissue loss (48.7% vs 30.2%), whereas claudication was more common among non-octogenarians (24.0% vs 9.8%) ( < .001). Below-knee bypass target (72.2% vs 59.3%) and prosthetic conduit utilization (58.5% vs 43.7%) were more frequent in octogenarians ( < .001 each). Overall hospital length of stay was longer among patients > 80 years (median 6 days [interquartile range [IQR] 4-9] vs 5 days [IQR 4-8], = .017). The overall 30-day (5.6% vs 1.5%) and one-year mortality rates (25.6% vs 7.9%) were higher among octogenarians ( < .001 each). On multivariable analysis, age greater than 80 years was found to be an independent risk factor for postoperative mortality (OR 3.79 [1.75-8.20], = .0007).
Octogenarians undergoing bypass femoropopliteal bypass surgery have considerably worse postoperative outcomes, compared with non-octogenarians. These data may help inform elderly patients prior to undergoing open lower extremity revascularization.
在 80 岁以上人群中，下肢动脉重建术存在争议；然而，老年人群的手术旁路适应证更高。本研究的目的是比较股腘旁路手术后 80 岁以上患者和非 80 岁患者的术后结果。
我们对 1995 年至 2020 年期间进行的股腘旁路手术进行了区域性多机构数据库查询。对电子病历进行了单独的回顾，以获取手术和术后数据。使用单变量和多变量逻辑回归来确定术后结果的预测因素。
在 1315 例接受股腘旁路手术的患者中，234 例（17.8%）为 80 岁以上患者。80 岁以上患者更频繁地因下肢组织缺失而行旁路手术（48.7% vs. 30.2%），而非 80 岁患者更常见于跛行（24.0% vs. 9.8%）（<0.001）。80 岁以上患者的膝下旁路目标（72.2% vs. 59.3%）和假体导管使用率（58.5% vs. 43.7%）更高（<0.001 各）。>80 岁患者的总住院时间更长（中位数 6 天 [四分位距 [IQR] 4-9] 比 5 天 [IQR 4-8]，=0.017）。80 岁以上患者的 30 天（5.6% vs. 1.5%）和 1 年死亡率（25.6% vs. 7.9%）更高（<0.001 各）。多变量分析发现，年龄>80 岁是术后死亡的独立危险因素（OR 3.79 [1.75-8.20]，=0.0007）。
与非 80 岁患者相比，接受股腘旁路手术的 80 岁以上患者术后结果明显更差。这些数据可能有助于在进行下肢动脉重建术之前告知老年患者。
