Age stratified, perioperative, and one-year mortality after abdominal aortic aneurysm repair: a statewide experience.
OBJECTIVE
The purpose of this study was to determine the in-hospital, 30-day, and 365-day mortality for the open repair of abdominal aortic aneurysms (AAAs), when stratified by age, in the general population. Age stratification could provide clinicians with information more applicable to an individual patient than overall mortality figures.


METHODS
In a retrospective analysis, data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1995 to 1999. Out-of-hospital mortality was determined via linkage to the state death registry. All patients undergoing AAA repair as coded by International Classification of Diseases, 9th Revision (ICD-9) procedure code 38.44 and diagnosis codes 441.4 (intact) and 441.3/441.5 (ruptured) in California were identified. Patients <50 years of age were excluded. We determined in-hospital, 30-day, and 365-day mortality, and stratified our findings by patient age. Multivariate logistic regression was used to determine predictors of mortality in the intact and ruptured AAA cohorts.


RESULTS
We identified 12,406 patients (9,778 intact, 2,628 ruptured). Mean patient age was 72.4 +/- 7.2 years (intact) and 73.9 +/- 8.2 (ruptured). Men comprised 80.9% of patients, and 90.8% of patients were white. Overall, intact AAA patient mortality was 3.8% in-hospital, 4% at 30 days, and 8.5% at 365 days. There was a steep increase in mortality with increasing age, such that 365-day mortality increased from 2.9% for patients 51 to 60 years old to 15% for patients 81 to 90 years old. Mortality from day 31 to 365 was greater than both in-hospital and 30-day mortality for all but the youngest intact AAA patients. Perioperative (in-hospital and 30-day) mortality for ruptured cases was 45%, and mortality at 1 year was 54%.


CONCLUSIONS
There is continued mortality after the open repair of AAAs during postoperative days 31 to 365 that, for many patients, is greater than the perioperative death rate. This mortality increases dramatically with age for both intact and ruptured AAA repair.
Center for Surgical Outcomes and Quality, UCLA School of Medicine, West Los Angeles Veterans' Administration Medical Center, Los Angeles, CA, USA. drigberg@mednet.ucla.edu
David A
DA
Rigberg
David S
DS
Zingmond
Marcia L
ML
McGory
Melinda A
MA
Maggard
Michelle
M
Agustin
Peter F
PF
Lawrence
Clifford Y
CY
Ko
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery; D002140:California / Q000453:epidemiology; D019992:Databases as Topic / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality*