Operative morbidity and mortality in octogenarians after carotid endarterectomy: a propensity score matching study.
BACKGROUND
Carotid endarterectomy remains the most effective surgical treatment for reducing the risk of stroke in patients with significant carotid stenosis. In fact, endovascular approach is associated with a higher incidence of perioperative and long-term minor stroke when compared to carotid endarterectomy although long-term functional outcome and risk of major stroke are similar. However, advanced age resulted to be associated with an increased risk of complications after carotid endarterectomy. Therefore, we decided to evaluate the outcome of carotid endarterectomy in octogenarians in our high-volume center.


METHODS
Data of all patients who underwent CEA between June 2009 and December 2014 were retrospectively recorded. Patients were categorized as aged <80 or ≥80 years. Propensity score matching based on baseline clinical variables was performed to correct for any bias. Primary outcome was the difference in combined stroke and death. Secondary outcomes included incidence of myocardial infarction, surgical reintervention, unplanned intensive care unit admission and length of hospital stay.


RESULTS
A total of 2463 carotid endarterectomies were performed, including 439 patients aged ≥80 years. After propensity score adjustment all octogenarians were matched one-to-one to younger patients. No differences in combined stroke and death were found (1.10% in octogenarians vs. 0.46% in younger patients; P=0.45). Octogenarians had an increased length of hospital stay when compared to younger patients (3.1±0.7 vs. 3.4±1.3 days; P=0.0001). No differences in other secondary outcomes were found.


CONCLUSIONS
Age ≥80 years does not entail an increased perioperative risk after carotid endarterectomy. Hence, surgical carotid revascularization in octogenarians can be regarded as a safe and viable alternative to best medical therapy alone when performed in high-volume centers.
Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute for Research and Care, Milan, Italy - pasin.laura@hsr.it.
Laura
L
Pasin
Department of Vascular Surgery, San Raffaele Scientific Institute for Research and Care, Milan, Italy.
Massimiliano M
MM
Marrocco Trischitta
Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute for Research and Care, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
Giovanni
G
Landoni
M. Aresu Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
Desiderio
D
Piras
Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute for Research and Care, Milan, Italy.
Pasquale
P
Nardelli
Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute for Research and Care, Milan, Italy.
Guglielmo
G
Cornero
Department of Vascular Surgery, San Raffaele Scientific Institute for Research and Care, Milan, Italy.
Roberto
R
Chiesa
Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute for Research and Care, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
Alberto
A
Zangrillo
D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome