title: Lower Extremity Arterial Reconstruction in Octogenarians and Older.
abstract: BACKGROUND
  Despite previous single-institution studies showing that lower extremity arterial reconstruction (LEAR) in octogenarians and older patients may be undertaken with acceptable postoperative morbidity and mortality, there continues to be significant reluctance, in the vascular surgical community, to undertaking these complex revascularization procedures in this very elderly population. We undertook this study in an effort to determine the outcomes of LEAR in octogenarians and older patients on a national level.
  
  
  METHODS
  The American College of Surgeons' National Surgical Quality Improvement Program database was queried to identify all patients who underwent LEAR between January 1, 2005 and December 31, 2009. Patient demographics and presenting comorbidities were recorded, and multivariate analyses were performed to compare outcomes in patients 80 and older to those in younger patients.
  
  
  RESULTS
  There were 19,028 patients who underwent open infrainguinal LEAR during this time period. Patients ≥80 comprised 18% (3,486 patients), and patients <80 years comprised 82% (15,542 patients). Multivariate analysis demonstrated that patients aged ≥80 years had an increased likelihood of mortality (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.42-2.26), cardiovascular (OR, 1.46; 95% CI, 1.12-1.89), respiratory (OR, 1.37; 95% CI, 1.12-1.67), and renal (OR, 1.57; 95% CI, 1.27-1.95) complications. There was, however, no significant difference in the likelihood of graft failure (OR, 1.04; 95% CI, 0.86-1.27), wound infection (OR, 0.92; 95% CI, 0.79-1.06), or major amputation (OR, 0.59; 95% CI, 0.13-2.74) between these 2 groups.
  
  
  CONCLUSIONS
  LEAR in octogenarians is associated with an increased risk of postoperative morbidity and mortality but no increased risk of wound infection, amputation, or graft failure.
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Hamdi
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Batul
authors.initials: B
authors.lastname: Al-Zubeidy
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Augustine
authors.initials: A
authors.lastname: Obirieze
authors.affiliation: Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: David
authors.initials: D
authors.lastname: Rose
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
authors.initials: E
authors.lastname: Cornwell
authors.affiliation: Department of Medicine, Howard University College of Medicine and Hospital, Washington, DC.
authors.forename: Thomas
authors.initials: T
authors.lastname: Obisesan
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
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001158:Arteries / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality