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Comparative Study
. 2018 Dec 18;13(1):129.
doi: 10.1186/s13019-018-0814-6.

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Takeshi Aoyama  1   2   3 , Susumu Kunisawa  2 , Kiyohide Fushimi  4 , Teiji Sawa  1 , Yuichi Imanaka  5
Affiliations
Comparative Study

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Takeshi Aoyama et al. J Cardiothorac Surg. .

Abstract

Background: In recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients.

Methods: Data of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching.

Results: The study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86-1.29 (p = 0.61) with reference to conservative treatment.

Conclusions: All-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.

Keywords: Activities of daily living; Aortic dissection; Complication; Elderly; Mortality; Propensity score matching analysis.

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Conflict of interest statement

Ethics approval and consent to participate

This study was performed with the approval of the ethics committee of Kyoto University (approval number: R0135).

Consent for publication

Not applicable.

Competing interests

All authors declared that they had no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Management of AAD based on the age group (5-year increments)
See this image and copyright information in PMC

References

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