title: The age effect in increasing operative mortality following delay in elective abdominal aortic aneurysm repair.
abstract: BACKGROUND
  Elective repair of large abdominal aortic aneurysms (AAAs) is associated with the risk of significant perioperative mortality. When abdominal aneurysm repair is delayed, patients with asymptomatic large AAAs face the risk of death from rupture. In addition to the risk of rupture, the advancing age of the patients adds a future operative risk. This risk has been historically documented in age groups. However, a more accurate representation of the increasing operative risk with age is needed.
  
  
  METHODS
  We analyzed all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent endovascular or open repair for asymptomatic infrarenal AAA between 2005 and 2012. Multivariable logistic regression was used to evaluate the effect of increasing age and operative delay on 30-day postoperative mortality.
  
  
  RESULTS
  There were 27,576 patients who underwent AAA repair during the study period (mean age 73.5 years, standard deviation 8.6, 80% male, 24% open repair). There was a linear relative increase of 5% (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04-1.06, P < 0.001) in the odds of operative death after AAA repair with each year of operative delay irrespective of treatment approach. There was a linear relative increase of 4% for endovascular aneurysm repair (OR 1.04, 95% CI 1.02-1.05, P < 0.001) and 6% for open repair (OR 1.06, 95% CI 1.04-1.08, P < 0.001) with each year of delay in repair.
  
  
  CONCLUSIONS
  Because of increasing age, delay in surgery is associated with uniform increase in the risk of perioperative mortality in asymptomatic patients who meet criteria for AAA repair. It is important for surgeons to incorporate this more accurate estimation of operative risk into discussions with patients who qualify for treatment yet decide to forgo surgery for the repair of their AAA.
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Isibor J
authors.initials: IJ
authors.lastname: Arhuidese
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Aitua
authors.initials: A
authors.lastname: Salami
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Tammam
authors.initials: T
authors.lastname: Obeid
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Umair
authors.initials: U
authors.lastname: Qazi
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Abularrage
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Bruce
authors.initials: B
authors.lastname: Perler
authors.affiliation: Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: bmalas1@jhmi.edu.
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: Malas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*