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. 2023 Jun;30(3):419-432.
doi: 10.1177/15266028221083460. Epub 2022 Mar 21.

Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Anna J Alberga  1   2 , Jorg L de Bruin  1 , Frederico Bastos Gonçalves  3 , Eleonora G Karthaus  4 , Janneke A Wilschut  2 , Joost A van Herwaarden  5 , Jan J Wever  6 , Hence J M Verhagen  1 ; Collaboration With the Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing
Collaborators, Affiliations

Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Anna J Alberga et al. J Endovasc Ther. 2023 Jun.

Abstract

Purpose: Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data.

Methods: All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians.

Results: The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8-3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2-2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1-3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8-2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4-0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4-0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6-0.8).

Conclusion: Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.

Keywords: abdominal aortic aneurysm; endovascular aneurysm repair; open surgical repair; registry; rupture.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.J.W.: consultant for Cordis/Cardinal Health, former consultant for Baxter. J.v.H.: is or has been consultant for Cook Medical, Gore Medical, Medtronic, Philips Medical Systems and Terumo Aortic. H.V.: consultant for Medtronic, WL Gore, Terumo, Endologix, Arsenal AAA, and Philips. Speakers bureau: Abbott.

Figures

Figure 1.
Figure 1.
Flow diagram of included octogenarians and non-octogenarians following rAAA-repair. DSAA, Dutch Surgical Aneurysm Audit; EVAR, endovascular aneurysm repair; OSR, open surgical repair; rAAA, ruptured abdominal aortic aneurysm.
Figure 2.
Figure 2.
Forest plots showing the results of multivariable logistic regression analyses for EVAR (A) and OSR (B) to assess the association of patient-related risk factors with perioperative mortality in octogenarians (using original data completed by multiple imputation). OR>1 indicates higher mortality. EVAR, endovascular aneurysm repair; OSR, open surgical repair.
Figure 3.
Figure 3.
Forest plots showing the results of multivariable logistic regression analyses for EVAR (A) and OSR (B) to assess the association of patient-related risk factors with major complications in octogenarians (using original data completed by multiple imputation). OR>1 indicates more major complications. EVAR, endovascular aneurysm repair; OSR, open surgical repair.
See this image and copyright information in PMC

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