title: Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014.
abstract: OBJECTIVE
  To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014.
  
  
  METHODS
  2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR).
  
  
  RESULTS
  Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences (p = .204 and p = .134). When rAAA patients were categorized into age groups (80-84 years, 85-89 years, 90+) crude survival diminished with increasing age, but long-term survival was not (p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR (p = .007), hazard ratio 1.3 (95% CI 1.1-1.6, p < .012).
  
  
  CONCLUSIONS
  There is a high (50%) peri-operative mortality after surgery for rAAA in octo- and nonagenarians, with no significant differences between the sexes and worse survival with increasing age. However, if a patient has survived the initial 90 days, long-term survival in this very old cohort is surprisingly good at more than 50% after 5 years, only slightly less than the general population.
authors.affiliation: Vascular Centre, Skåne University Hospital, Malmö, Sweden. Electronic address: b.sonesson@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Sonesson
authors.affiliation: Vascular Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Björses
authors.affiliation: Vascular Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Dias
authors.affiliation: Department of Biostatistics, Skåne University Hospital, Lund, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Rylance
authors.affiliation: Department of Vascular Surgery, Uppsala, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Mani
authors.affiliation: Department of Vascular Surgery, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wanhainen
authors.affiliation: Vascular Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Resch
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
keywords: Endovascular aneurysm repair; Octo- and nonagenarians; Open repair; Outcome; Ruptured abdominal aortic aneurysm