title: Age versus comorbidities as risk factors for complications after elective abdominal aortic reconstructive surgery.
abstract: OBJECTIVE
  This study estimated the association between age and in-hospital postoperative complications, controlling for known or suspected risk factors, in a series of patients undergoing elective abdominal aortic reconstructive surgery (AAR).
  
  
  METHODS
  This retrospective cohort study of outcome data with multivariate logistic regression analysis was conducted at Emory University Hospital, a tertiary care, university-affiliated hospital. All patients undergoing elective AAR between Jan 1, 1986, and Aug 1, 1996, were included (n = 856). An estimate of the odds ratio (OR) and 95% CI for the association between patient age and in-hospital major morbidity or mortality after elective AAR was made, controlling for significant risk factors.
  
  
  RESULTS
  Among the 856 patients, 170 had a nonfatal complication (136 with major and 34 with minor complications), and 11 patients (1.3%) died. The final logistic regression model demonstrated a mild association between increasing age and rate of major postoperative complications, including death (for each increase in age of 10 years: OR, 1.23; 95% CI, 1.00-1.52; P =.052). Other significant covariates in the final model included cardiac disease (OR, 2.84; 95% CI, 1.18-6.86; P =.020), pulmonary disease (OR, 1.96; 95% CI, 1.35-2.84; P =.0004), and renal disease (OR, 2.57; 95% CI, 1.66-3.99; P =.0001). Increasing age was associated with a moderate increase in the rate of death (for each increase in age of 10 years: OR, 2.74; 95% CI, 1.22-6.16; P =.015) in a model with cardiac disease as the only significant covariate (OR, 14.67; 95% CI, 3.46-62.16; P =.0003).
  
  
  CONCLUSIONS
  For patients undergoing elective AAR, increasing patient age is associated with a small increase in risk for in-hospital morbidity or mortality. However, significant cardiac, pulmonary, or renal disease is associated with a much greater risk of postoperative complications, and, therefore, advanced age should not be the sole basis of exclusion for otherwise suitable candidates for elective AAR.
authors.affiliation: Department of Anesthesiology, Emory University Hospital, Atlanta, GA 30322, USA. arnold_berry@emory.org
authors.forename: A J
authors.initials: AJ
authors.lastname: Berry
authors.forename: R B
authors.initials: RB
authors.lastname: Smith
authors.forename: W S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: E L
authors.initials: EL
authors.lastname: Chaikof
authors.forename: T F
authors.initials: TF
authors.lastname: Dodson
authors.forename: A B
authors.initials: AB
authors.lastname: Lumsden
authors.forename: A A
authors.initials: AA
authors.lastname: Salam
authors.forename: V
authors.initials: V
authors.lastname: Weiss
authors.forename: S
authors.initials: S
authors.lastname: Konigsberg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000401:mortality