title: Outcome after open repair of ruptured abdominal aortic aneurysm in patients>80 years old: a systematic review and meta-analysis.
abstract: BACKGROUND
  The role of open repair in the management of ruptured abdominal aortic aneurysm (RAAA) in patients>80 years old is questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies.
  
  
  METHODS
  Studies on open repair of RAAA in patients>80 years old were identified in July 2010. The immediate and intermediate results were expressed as pooled proportions with 95% confidence interval (95% CI). Linear regression and meta-regression were performed to evaluate the impact of variables on the immediate postoperative mortality.
  
  
  RESULTS
  Pooled analysis of 29 studies showed that the risk of immediate postoperative mortality in patients>80 years old was significantly higher than in younger patients (risk ratio 1.440, 95%CI 1.365-1.519, I2 36.8%, P=0.002; risk difference 19.4%, 95% CI 16.4-22.4%, I2 38.8%, P=0.019). Pooled analysis of 36 studies showed an immediate postoperative mortality rate of 59.2% (95% CI 55.7-62.5, I2 35.62). Immediate postoperative mortality in patients<80 years old positively correlated with that of patients>80 years old (rho: 0.686, P<0.0001). Intermediate survival data of 111 operative survivors were available from six studies, and their pooled survival rates at 1-, 2-, and 3-year were 82.4, 75.6, and 68.7%, respectively.
  
  
  CONCLUSIONS
  Immediate and intermediate survival rates of patients>80 years old after open repair of RAAA are acceptable. These findings suggest a more confident approach toward emergency repair of RAAA in the very elderly.
authors.affiliation: Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Maria Alessandra
authors.initials: MA
authors.lastname: Mazziotti
authors.forename: Rosalba
authors.initials: R
authors.lastname: Paone
authors.forename: Sani
authors.initials: S
authors.lastname: Laukontaus
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome