title: Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm.
abstract: OBJECTIVE
  To investigate whether advanced age may be a reason to refrain from treatment in patients with an acute abdominal aortic aneurysm (AAAA).
  
  
  METHODS
  This was a retrospective cohort study that took place in a tertiary care university hospital with a 45-bed intensive care unit. Two hundred seventy-one patients with manifest AAAA, admitted and treated between January 2000 and February 2008, were included. Six patients died during operation and were included in the final analysis to ensure an intention-to-treat protocol, resulting in 234 men and 37 women with a mean age of 72 ± 7.8 years (range, 54-88 years). Forty-six patients (17%) were 80 years or older. Interventions involved open or endovascular AAAA repair.
  
  
  RESULTS
  Mean follow-up was 33 ± 30.4 months (including early deaths). Mean hospital length of stay was 16.9 ± 20 days for patients younger than 80 and 13 ± 16.7 days for patients older than 80 years of age. Kaplan-Meier survival analysis revealed a significantly better survival for the younger patients (P < .05). Stratification based on urgency or type of treatment did not change the difference. Two-year actuarial survival was 70% for patients younger than 80 and 52% for those older than 80. At 5-year follow-up, these figures were 62% and 29%, respectively. Mean survival in patients older than 80 was 39.8 ± 6.8 months versus 64.5 ± 3.0 months in those younger than 80.
  
  
  CONCLUSIONS
  For octogenarians, our liberal strategy of treating patients with AAAA was associated with satisfactory short- and long-term outcome, with no difference with regard to disease- or procedure-related morbidity between the younger and older group. Assuming an integrated system for managing AAAA is in place, advanced age is not a reason to deny patients surgery.
authors.affiliation: Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Margot L J
authors.initials: ML
authors.lastname: Scheer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pol
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Haveman
authors.forename: Ignace F J
authors.initials: IF
authors.lastname: Tielliu
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
authors.forename: Jan J A M
authors.initials: JJ
authors.lastname: Van Den Dungen
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Nijsten
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality