Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution
Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcome...
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| Veröffentlicht in: | Annals of vascular surgery 2024-02, Vol.99, p.175-185 |
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| creator | Duong, William Grigorian, Areg Yuen, Sarah Nahmias, Jeffry Kabutey, Nii-Kabu Farzaneh, Cyrus Donayre, Carlos Fujitani, Roy M. |
| description | Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcomes from endovascular aortic repair (EVAR) is unclear. We study the effect of advanced age, as an independent risk factor for mortality in octogenarian geriatric patients (OGPs) compared to nonoctogenarian geriatric patients (NOGPs) undergoing EVAR.
The 2011–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65 years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs.
Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA |
| doi_str_mv | 10.1016/j.avsg.2023.07.107 |
| format | Article |
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The 2011–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65 years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs.
Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA <5.5 cm (46.7% vs. 54.9%, P < 0.001) and AAA <5.0 cm (19.2% vs. 24.0%, P < 0.001). Nearly 90% of male and over 80% of female NOGPs and OGPs treated for AAA <5.0 cm were asymptomatic. Octogenarian geriatric patients (OGPs) had less dyspnea (15.3% vs. 17.3%, P = 0.01), chronic obstructive pulmonary disease (16.1% vs. 20.5%, P < 0.001), diabetes (12.7% vs. 17.8%, P < 0.001), and smoking (13.2% vs. 36.3%, P < 0.001) compared to NOGPs. Octogenarian geriatric patients (OGPs) were found to have a greater length of stay (2 days vs. 1 day, P < 0.001), as well as rate of mortality (3.4% vs. 1.7%, P < 0.001). Both symptomatic and asymptomatic OGPs had a higher rate of mortality than their NOGP counterparts (symptomatic 16% vs. 9.5%, P < 0.001; asymptomatic 1.3% vs. 0.5%, P < 0.001). Multivariate logistic regression analysis showed OGPs to have increased overall associated risk of mortality compared to NOGPs (odds ratio (OR) 1.88, confidence interval (CI) 1.39–2.54, P < 0.001), as well as in the symptomatic (OR 1.54, CI 1.06–2.23, P < 0.001) and asymptomatic cohorts (OR 2.66, CI 1.59–4.45, P < 0.001).
Octogenarian geriatric patients (OGPs) accounted for over a quarter of geriatric patients undergoing EVAR. This elderly group was associated with an increased rate and risk of mortality compared to NOGPs, even when controlling for known risk factors for mortality. Given this increased risk of mortality in OGPs undergoing EVAR, elective treatment of AAAs in this advanced age group should be performed with caution, particularly in those with diameters in which the risk of rupture may not warrant repair.]]></description><identifier>ISSN: 0890-5096</identifier><identifier>EISSN: 1615-5947</identifier><identifier>DOI: 10.1016/j.avsg.2023.07.107</identifier><identifier>PMID: 37827211</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - complications ; Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - surgery ; Blood Vessel Prosthesis Implantation - adverse effects ; Endovascular Procedures - adverse effects ; Female ; Humans ; Male ; Octogenarians ; Postoperative Complications - etiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome</subject><ispartof>Annals of vascular surgery, 2024-02, Vol.99, p.175-185</ispartof><rights>2023</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c307t-2581eac93d22fa26647e3963493eebae83051c3c11f7c5b53837f972587fe08e3</cites><orcidid>0000-0003-4599-6676</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.avsg.2023.07.107$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37827211$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Duong, William</creatorcontrib><creatorcontrib>Grigorian, Areg</creatorcontrib><creatorcontrib>Yuen, Sarah</creatorcontrib><creatorcontrib>Nahmias, Jeffry</creatorcontrib><creatorcontrib>Kabutey, Nii-Kabu</creatorcontrib><creatorcontrib>Farzaneh, Cyrus</creatorcontrib><creatorcontrib>Donayre, Carlos</creatorcontrib><creatorcontrib>Fujitani, Roy M.</creatorcontrib><title>Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution</title><title>Annals of vascular surgery</title><addtitle>Ann Vasc Surg</addtitle><description><![CDATA[Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcomes from endovascular aortic repair (EVAR) is unclear. We study the effect of advanced age, as an independent risk factor for mortality in octogenarian geriatric patients (OGPs) compared to nonoctogenarian geriatric patients (NOGPs) undergoing EVAR.
The 2011–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65 years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs.
Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA <5.5 cm (46.7% vs. 54.9%, P < 0.001) and AAA <5.0 cm (19.2% vs. 24.0%, P < 0.001). Nearly 90% of male and over 80% of female NOGPs and OGPs treated for AAA <5.0 cm were asymptomatic. Octogenarian geriatric patients (OGPs) had less dyspnea (15.3% vs. 17.3%, P = 0.01), chronic obstructive pulmonary disease (16.1% vs. 20.5%, P < 0.001), diabetes (12.7% vs. 17.8%, P < 0.001), and smoking (13.2% vs. 36.3%, P < 0.001) compared to NOGPs. Octogenarian geriatric patients (OGPs) were found to have a greater length of stay (2 days vs. 1 day, P < 0.001), as well as rate of mortality (3.4% vs. 1.7%, P < 0.001). Both symptomatic and asymptomatic OGPs had a higher rate of mortality than their NOGP counterparts (symptomatic 16% vs. 9.5%, P < 0.001; asymptomatic 1.3% vs. 0.5%, P < 0.001). Multivariate logistic regression analysis showed OGPs to have increased overall associated risk of mortality compared to NOGPs (odds ratio (OR) 1.88, confidence interval (CI) 1.39–2.54, P < 0.001), as well as in the symptomatic (OR 1.54, CI 1.06–2.23, P < 0.001) and asymptomatic cohorts (OR 2.66, CI 1.59–4.45, P < 0.001).
Octogenarian geriatric patients (OGPs) accounted for over a quarter of geriatric patients undergoing EVAR. This elderly group was associated with an increased rate and risk of mortality compared to NOGPs, even when controlling for known risk factors for mortality. Given this increased risk of mortality in OGPs undergoing EVAR, elective treatment of AAAs in this advanced age group should be performed with caution, particularly in those with diameters in which the risk of rupture may not warrant repair.]]></description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - complications</subject><subject>Aortic Aneurysm, Abdominal - diagnostic imaging</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Octogenarians</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0890-5096</issn><issn>1615-5947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1rGzEQhkVpaZykfyCHoGMv6-rDu9JCL8akTSAl0Cb0KMbaWSOzK7mjXYPz67vGSY45Dcw87wvzMHYlxVwKWX3bzmGfN3MllJ4LM-3MBzaTlSyLsl6Yj2wmbC2KUtTVGTvPeSuEVHZhP7MzbawySsoZe76LnhAyNvxXogG6MBx4iPzBD2mDEShAzPwpNkibFOKG38Qm7SH7sQPiyykSPF9GHOmQe_4bdxCIt4n4nx66DuntlvlfIII4ZL6CcQgpXrJPLXQZv7zMC_b04-ZxdVvcP_y8Wy3vC6-FGQpVWonga90o1YKqqoVBXVd6UWvENaDVopReeylb48t1qa02bW2mmGlRWNQX7Oupd0fp34h5cH3IHrsOIqYxO2WN0VbYUk2oOqGeUs6ErdtR6IEOTgp3dO627ujcHZ07YaadmULXL_3jusfmLfIqeQK-nwCcvtwHJJd9wOixCYR-cE0K7_X_BwqilLs</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Duong, William</creator><creator>Grigorian, Areg</creator><creator>Yuen, Sarah</creator><creator>Nahmias, Jeffry</creator><creator>Kabutey, Nii-Kabu</creator><creator>Farzaneh, Cyrus</creator><creator>Donayre, Carlos</creator><creator>Fujitani, Roy M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4599-6676</orcidid></search><sort><creationdate>20240201</creationdate><title>Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution</title><author>Duong, William ; Grigorian, Areg ; Yuen, Sarah ; Nahmias, Jeffry ; Kabutey, Nii-Kabu ; Farzaneh, Cyrus ; Donayre, Carlos ; Fujitani, Roy M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-2581eac93d22fa26647e3963493eebae83051c3c11f7c5b53837f972587fe08e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - complications</topic><topic>Aortic Aneurysm, Abdominal - diagnostic imaging</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Octogenarians</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duong, William</creatorcontrib><creatorcontrib>Grigorian, Areg</creatorcontrib><creatorcontrib>Yuen, Sarah</creatorcontrib><creatorcontrib>Nahmias, Jeffry</creatorcontrib><creatorcontrib>Kabutey, Nii-Kabu</creatorcontrib><creatorcontrib>Farzaneh, Cyrus</creatorcontrib><creatorcontrib>Donayre, Carlos</creatorcontrib><creatorcontrib>Fujitani, Roy M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duong, William</au><au>Grigorian, Areg</au><au>Yuen, Sarah</au><au>Nahmias, Jeffry</au><au>Kabutey, Nii-Kabu</au><au>Farzaneh, Cyrus</au><au>Donayre, Carlos</au><au>Fujitani, Roy M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution</atitle><jtitle>Annals of vascular surgery</jtitle><addtitle>Ann Vasc Surg</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>99</volume><spage>175</spage><epage>185</epage><pages>175-185</pages><issn>0890-5096</issn><eissn>1615-5947</eissn><abstract><![CDATA[Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcomes from endovascular aortic repair (EVAR) is unclear. We study the effect of advanced age, as an independent risk factor for mortality in octogenarian geriatric patients (OGPs) compared to nonoctogenarian geriatric patients (NOGPs) undergoing EVAR.
The 2011–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65 years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs.
Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA <5.5 cm (46.7% vs. 54.9%, P < 0.001) and AAA <5.0 cm (19.2% vs. 24.0%, P < 0.001). Nearly 90% of male and over 80% of female NOGPs and OGPs treated for AAA <5.0 cm were asymptomatic. Octogenarian geriatric patients (OGPs) had less dyspnea (15.3% vs. 17.3%, P = 0.01), chronic obstructive pulmonary disease (16.1% vs. 20.5%, P < 0.001), diabetes (12.7% vs. 17.8%, P < 0.001), and smoking (13.2% vs. 36.3%, P < 0.001) compared to NOGPs. Octogenarian geriatric patients (OGPs) were found to have a greater length of stay (2 days vs. 1 day, P < 0.001), as well as rate of mortality (3.4% vs. 1.7%, P < 0.001). Both symptomatic and asymptomatic OGPs had a higher rate of mortality than their NOGP counterparts (symptomatic 16% vs. 9.5%, P < 0.001; asymptomatic 1.3% vs. 0.5%, P < 0.001). Multivariate logistic regression analysis showed OGPs to have increased overall associated risk of mortality compared to NOGPs (odds ratio (OR) 1.88, confidence interval (CI) 1.39–2.54, P < 0.001), as well as in the symptomatic (OR 1.54, CI 1.06–2.23, P < 0.001) and asymptomatic cohorts (OR 2.66, CI 1.59–4.45, P < 0.001).
Octogenarian geriatric patients (OGPs) accounted for over a quarter of geriatric patients undergoing EVAR. This elderly group was associated with an increased rate and risk of mortality compared to NOGPs, even when controlling for known risk factors for mortality. Given this increased risk of mortality in OGPs undergoing EVAR, elective treatment of AAAs in this advanced age group should be performed with caution, particularly in those with diameters in which the risk of rupture may not warrant repair.]]></abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>37827211</pmid><doi>10.1016/j.avsg.2023.07.107</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4599-6676</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Aneurysm, Abdominal - complications Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - surgery Blood Vessel Prosthesis Implantation - adverse effects Endovascular Procedures - adverse effects Female Humans Male Octogenarians Postoperative Complications - etiology Retrospective Studies Risk Assessment Risk Factors Treatment Outcome |
| title | Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution |
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