Is old age a contraindication for surgical treatment in acute aortic dissection? A demographic study of national database registry in Taiwan.
BACKGROUND
Acute aortic dissection is usually presented as a surgical emergent condition with high mortality rate. Whether any patient of an advanced age suffering from acute aortic type A dissection or complicated type B dissection should be referred for surgery still deserves debating.


METHODS
A retrospective study including 5654 patients with acute aortic dissection was collected from the National Health Insurance Databases from 1996 to 2001. Age, initial treatment modality, and the late outcome were the main factors to be investigated. Patients are grouped into the young age group when ages are less or equal to 70 and the old age group when over 70. We further subdivided both groups into operative and nonoperative subgroups, respectively, depending on patients receiving surgical intervention for acute aortic dissection or not. The endpoint mortality was defined by the patient death either related to or unrelated to cardiac causes.


RESULTS
A total of 5654 cases are with the mean age of 65.6 +/- 14.0 years. The percentage of patients receiving operation was inversely related to the patient's age significantly (p < 0.05). In the old age group, the operative subgroup had both significantly higher survival rate at six-year follow-up than the nonoperative group for both patients on admission and 30-day survivors (43.4 +/- 3.5% vs. 29.8 +/- 2.3%, p < 0.05; 70.0 +/- 4.5% vs. 36.0 +/- 2.8%, p < 0.05). The annual attrition rates of mortality were significantly higher in the nonoperative subgroup for both patients on admission and 30-day survivors (p < 0.05).


CONCLUSIONS
The trend toward more conservative treatment in the elderly still occurs in our common practice even with improving surgical techniques. In our study, we suggest that pertinent surgical strategies for acute aortic dissection are necessary to improve the outcome in elderly patients.
Wu
I-Hui
IH
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Yu
Hsi-Yu
HY
Liu
Chih-Ho
CH
Chen
Yih-Sharng
YS
Wang
Shoei-Shun
SS
Lin
Fang-Yue
FY
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D003657:Decision Making; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome