title: Abdominal aortic aneurysm repair in nonagenarians.
abstract: BACKGROUND
  The feasibility of abdominal aortic aneurysm (AAA) repair in nonagenarians on a national level is largely unknown. We undertook this study to determine the outcomes of open and endovascular AAA repair in this population on a national level.
  
  
  METHODS
  A retrospective review of the Nationwide Inpatient Sample Database was conducted to determine all patients 90 years and older who underwent either an open or endovascular repair of a nonruptured AAA from 1997 to 2008. Preoperative comorbidities and postoperative complications in the inpatient setting were recorded. The primary end point was mortality. Secondary end points were postoperative neurologic, cardiac, and respiratory complications. This group was then compared with all adult patients less than 90 years old (age, 18-89) who had undergone repair of a nonruptured AAA during this same period.
  
  
  RESULTS
  Four hundred twenty-three patients 90 years and older underwent repair of a nonruptured AAA (compared with 52,370 < 90). Of these, 132 patients underwent open repair (31%) and 291 (69%) underwent endovascular repair. Inpatient mortality was 18.3% for the ≥90 open, 4.6% for the <90 open, 3.1% for the ≥90 endovascular, and 1.2% for <90 endovascular group.
  
  
  CONCLUSIONS
  Open repair of AAA's in nonagenarians is associated with significantly high perioperative mortality, whereas endovascular repair is feasible with acceptable perioperative mortality. This mortality, although significantly higher than that obtained for endovascular repair in patients <90, is nonetheless not significantly different for the mortality noted for patients <90 undergoing open AAA repair.
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC. Electronic address: kakra.hughes@howard.edu.
authors.forename: Kakra
authors.initials: K
authors.lastname: Hughes
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Abdulrahman
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Tahira
authors.initials: T
authors.lastname: Prendergast
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: David A
authors.initials: DA
authors.lastname: Rose
authors.affiliation: Department of Internal Medicine, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Sharon
authors.initials: S
authors.lastname: Ongu'ti
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tran
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
authors.forename: Thomas
authors.initials: T
authors.lastname: Obisesan
authors.affiliation: Department of Surgery, Upstate Medical University, Syracuse, NY.
authors.forename: Kwame S
authors.initials: KS
authors.lastname: Amankwah
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult