The age effect in increasing operative mortality following delay in elective abdominal aortic aneurysm repair presented at the society for clinical vascular surgery 42nd Annual Symposium, Carlsbad, CA, March 18-22, 2014.

Isibor J. Arhuidese, Aitua Salami, Tammam Obeid, Umair Qazi, Christopher J. Abularrage, James H. Black, Bruce Perler, Mahmoud B. Malas

Research output: Contribution to journalArticlepeer-review

Abstract

Background Elective repair of large abdominal aortic aneurysms (AAAs) is associated with the risk of significant perioperative mortality. When abdominal aneurysm repair is delayed, patients with asymptomatic large AAAs face the risk of death from rupture. In addition to the risk of rupture, the advancing age of the patients adds a future operative risk. This risk has been historically documented in age groups. However, a more accurate representation of the increasing operative risk with age is needed. Methods We analyzed all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent endovascular or open repair for asymptomatic infrarenal AAA between 2005 and 2012. Multivariable logistic regression was used to evaluate the effect of increasing age and operative delay on 30-day postoperative mortality. Results There were 27,576 patients who underwent AAA repair during the study period (mean age 73.5 years, standard deviation 8.6, 80% male, 24% open repair). There was a linear relative increase of 5% (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04-1.06, P < 0.001) in the odds of operative death after AAA repair with each year of operative delay irrespective of treatment approach. There was a linear relative increase of 4% for endovascular aneurysm repair (OR 1.04, 95% CI 1.02-1.05, P < 0.001) and 6% for open repair (OR 1.06, 95% CI 1.04-1.08, P < 0.001) with each year of delay in repair. Conclusions Because of increasing age, delay in surgery is associated with uniform increase in the risk of perioperative mortality in asymptomatic patients who meet criteria for AAA repair. It is important for surgeons to incorporate this more accurate estimation of operative risk into discussions with patients who qualify for treatment yet decide to forgo surgery for the repair of their AAA.

Original languageEnglish (US)
Pages (from-to)1181-1187
Number of pages7
JournalAnnals of Vascular Surgery
Volume29
Issue number6
DOIs
StatePublished - Aug 1 2015

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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