Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA.
Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA.
Ann Vasc Surg. 2024 Feb;99:175-185. doi: 10.1016/j.avsg.2023.07.107. Epub 2023 Oct 10.
Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcomes from endovascular aneurysm repair (EVAR) is unclear. We study the effect of advanced age, as an independent risk factor for mortality in octogenarian geriatric patients (OGPs) compared to nonoctogenarian geriatric patients (NOGPs) undergoing EVAR.
The 2011-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65 years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs.
Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA <5.5 cm (46.7% vs. 54.9%, P < 0.001) and AAA <5.0 cm (19.2% vs. 24.0%, P < 0.001). Nearly 90% of male and over 80% of female NOGPs and OGPs treated for AAA <5.0 cm were asymptomatic. Octogenarian geriatric patients (OGPs) had less dyspnea (15.3% vs. 17.3%, P = 0.01), chronic obstructive pulmonary disease (16.1% vs. 20.5%, P < 0.001), diabetes (12.7% vs. 17.8%, P < 0.001), and smoking (13.2% vs. 36.3%, P < 0.001) compared to NOGPs. Octogenarian geriatric patients (OGPs) were found to have a greater length of stay (2 days vs. 1 day, P < 0.001), as well as rate of mortality (3.4% vs. 1.7%, P < 0.001). Both symptomatic and asymptomatic OGPs had a higher rate of mortality than their NOGP counterparts (symptomatic 16% vs. 9.5%, P < 0.001; asymptomatic 1.3% vs. 0.5%, P < 0.001). Multivariate logistic regression analysis showed OGPs to have increased overall associated risk of mortality compared to NOGPs (odds ratio (OR) 1.88, confidence interval (CI) 1.39-2.54, P < 0.001), as well as in the symptomatic (OR 1.54, CI 1.06-2.23, P < 0.001) and asymptomatic cohorts (OR 2.66, CI 1.59-4.45, P < 0.001).
Octogenarian geriatric patients (OGPs) accounted for over a quarter of geriatric patients undergoing EVAR. This elderly group was associated with an increased rate and risk of mortality compared to NOGPs, even when controlling for known risk factors for mortality. Given this increased risk of mortality in OGPs undergoing EVAR, elective treatment of AAAs in this advanced age group should be performed with caution, particularly in those with diameters in which the risk of rupture may not warrant repair.
老年患者在普通人群中所占比例不断增加，尤其是 80 岁以上的老年人数量明显增加。腹主动脉瘤（AAA）的发病率和患病率与年龄的增长明显相关。年龄对血管内修复术（EVAR）结果的影响尚不清楚。我们研究了与非 80 岁以上老年人（NOGPs）相比，80 岁以上老年人（OGPs）作为死亡率的独立危险因素对接受 EVAR 的 80 岁以上老年人（OGPs）的影响。
对美国外科医师学会国家外科质量改进计划（ACS NSQIP）程序目标血管数据库进行了查询，以确定因有症状和无症状原因接受 EVAR 的老年患者（>65 岁）。对 OGPs 和 NOGPs 之间的结果进行了多变量逻辑回归分析。
在接受 EVAR 的 10490 名老年患者中，7508 名（71.6%）为非 80 岁以上老年人，2982 名（28.4%）为 80 岁以上老年人。80 岁以上老年人中女性较多（82.3%比 76.7%）。与非 80 岁以上老年人相比，OGPs 中 AAA<5.5cm 的患者比例较低（46.7%比 54.9%，P<0.001），AAA<5.0cm 的患者比例较低（19.2%比 24.0%，P<0.001）。近 90%的男性和超过 80%的女性非 80 岁以上老年人和 80 岁以上老年人中 AAA<5.0cm 的患者均无症状。与非 80 岁以上老年人相比，80 岁以上老年人（OGPs）呼吸困难的发生率较低（15.3%比 17.3%，P=0.01），慢性阻塞性肺病（16.1%比 20.5%，P<0.001），糖尿病（12.7%比 17.8%，P<0.001）和吸烟（13.2%比 36.3%，P<0.001）的发生率较低。OGPs 的住院时间（2 天比 1 天，P<0.001）和死亡率（3.4%比 1.7%，P<0.001）也较高。有症状和无症状的 OGPs 的死亡率均高于非 80 岁以上老年人（有症状者为 16%比 9.5%，P<0.001；无症状者为 1.3%比 0.5%，P<0.001）。多变量逻辑回归分析显示，OGPs 的总死亡率与非 80 岁以上老年人相比风险更高（比值比（OR）1.88，95%置信区间（CI）1.39-2.54，P<0.001），包括有症状（OR 1.54，95%CI 1.06-2.23，P<0.001）和无症状（OR 2.66，95%CI 1.59-4.45，P<0.001）。
80 岁以上老年人（OGPs）占接受 EVAR 的老年患者的四分之一以上。与非 80 岁以上老年人相比，这个老年群体的死亡率和风险更高，即使控制了已知的死亡率危险因素也是如此。鉴于 OGPs 接受 EVAR 的死亡率较高，在这个年龄段，尤其是在破裂风险可能不需要修复的直径范围内，应谨慎选择治疗 AAA。
