Is prompt surgical treatment of an abdominal aortic aneurysm justified for someone in their eighties?
OBJECTIVE
The aim of this study is to review the early and long-term results and quality of life after abdominal aortic aneurysm (AAA) surgery in octogenarians to justify our prompt surgical intervention.


METHODS
We reviewed the consecutive 444 patients who underwent graft replacement of AAA in our center from October 1997 to September 2002. The median age of the patients was 72.3. An elective operation was carried out in 401 cases (90.3%) and an emergency operation in 43 cases (9.7%). We evaluated the early and long-term results of AAA surgical treatment, including the quality of life after hospital discharge.


RESULTS
There were 12 hospital deaths (2.7%) in the early outcomes, 11 of which (25.6%) were during emergency operations, and only one patient (0.2%) died among the elective cases (p <.0001). In the early results, the emergency operation (p = 0.0001) was the only risk factor in the early deaths investigated by the multivariate logistic regression; patients aged 80 years and over did not constitute a risk factor. There were 36 late deaths, but none related to AAA surgical treatment. The strongest predictors for late mortality included patients aged 80 years and over (p = 0.027), male gender (p = 0.048), chronic renal failure with preoperative serum creatinine level equal to or greater than 1.5 mg/dl (p = 0.043), a history of atherosclerotic obliterans (p = 0.009), and an emergency operation (p <.001) investigated by the Cox hazard multivariate logistic regression. Among the survivors, 86.1% of the patients aged 80 years and over were able to maintain their previous lifestyles with the independent activities of everyday life.


CONCLUSIONS
AAA surgical treatment in octogenarians had comparable results with younger patients, in either elective or emergency settings. The extension of indications for AAA elective surgery in octogenarians might lead to a lower rate of emergency settings and subsequently to better early and late surgical outcomes.
Tochii
Masato
M
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
Ogino
Hitoshi
H
Matsuda
Hitoshi
H
Minatoya
Kenji
K
Sasaki
Hiroaki
H
Kitamura
Soichiro
S
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D006299:Health Services for the Aged; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D018579:Patient Selection; D016016:Proportional Hazards Models; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome