Balamurugan Parvathy, Guduri Pavan, Hunt John P, Marr Alan, Greiffenstein Patrick, Schoen Jonathan, Stuke Lance, Duchesne Juan, Bellows Charles F, Smith Alison A
Department of Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana.
Department of Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana; University Medical Center, New Orleans, Louisiana.
J Surg Res. 2025 Jun;310:155-161. doi: 10.1016/j.jss.2025.03.028. Epub 2025 Apr 25.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) usage in the geriatric population has not been well studied. This study aimed to define REBOA use and complications in the geriatric population. It was hypothesized that geriatric patients may have greater rates of complications compared to younger patients due to geriatric patients having a greater likelihood of preexisting comorbidities.
Using the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry database, adult trauma patients were stratified by age (18-64 y versus ≥ 65 y). Data collected included demographic information, injury severity score (ISS), mechanism of injury, zone of placement, length of occlusion, development of acute kidney injury, and access site complications. Univariate analyses were performed with P value < 0.05 considered to be significant.
Of the 1156 patients, 157 (13.6%) were geriatric. There was no significant difference in ISS with both groups having a median ISS of 34 (interquartile range [IQR] 22, 43), P = 0.98. The distribution of REBOA zone placement was similar for both groups. The time of occlusion was not significantly different with geriatric median of 30 min (IQR 11,47) and nongeriatric median of 33 min (IQR 21, 60), P = 0.18. There was no significant difference in the rate of acute kidney injury (21.7% geriatric versus 22.1% nongeriatric, P = 1.0). There was a significantly lower rate of extremity ischemia (0% geriatric versus 3.7% nongeriatric, P = 0.006). There was no significant difference in rates of hematoma, arteriovenous fistula, stenosis, pseudoaneurysm, or distal embolism.
Age greater than or equal to 65 y was associated with a significantly lower rate of extremity limb ischemia. This difference could be due to preexisting comorbidities in this patient population. Future prospective studies are needed to further study this phenomenon.
主动脉复苏性血管内球囊阻断术（REBOA）在老年人群中的应用尚未得到充分研究。本研究旨在明确老年人群中REBOA的使用情况及并发症。研究假设，由于老年患者存在更多基础合并症，与年轻患者相比，其并发症发生率可能更高。
利用美国创伤外科协会创伤与急性护理手术复苏主动脉阻断登记数据库，将成年创伤患者按年龄分层（18 - 64岁与≥65岁）。收集的数据包括人口统计学信息、损伤严重程度评分（ISS）、损伤机制、放置区域、阻断时间、急性肾损伤的发生情况以及穿刺部位并发症。进行单因素分析，P值<0.05被认为具有统计学意义。
在1156例患者中，157例（13.6%）为老年患者。两组的ISS无显著差异，两组的ISS中位数均为34（四分位间距[IQR] 22, 43），P = 0.98。两组REBOA放置区域的分布相似。阻断时间无显著差异，老年患者的中位数为30分钟（IQR 11, 47），非老年患者的中位数为33分钟（IQR 21, 60），P = 0.18。急性肾损伤发生率无显著差异（老年患者为21.7%，非老年患者为22.1%，P = 1.0）。肢体缺血发生率显著较低（老年患者为0%，非老年患者为3.7%，P = 0.006）。血肿、动静脉瘘、狭窄、假性动脉瘤或远端栓塞的发生率无显著差异。
年龄大于或等于65岁与肢体缺血发生率显著较低相关。这种差异可能归因于该患者群体中存在的基础合并症。未来需要进行前瞻性研究以进一步探究这一现象。
