PMID- 24200132
OWN - NLM
STAT- MEDLINE
DCOM- 20140811
LR  - 20131216
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 28
IP  - 1
DP  - 2014 Jan
TI  - Outcomes after open repair of ruptured abdominal aortic aneurysms in 
      octogenarians: a 20-year, single-center experience.
PG  - 80-6
LID - S0890-5096(13)00393-2 [pii]
LID - 10.1016/j.avsg.2013.07.006 [doi]
AB  - BACKGROUND: The purpose of this study was to evaluate morbidity, mortality, and 
      survival in octogenarians undergoing open repair of ruptured abdominal aortic 
      aneurysms (RAAAs) in comparison to younger patients. METHODS: This investigation 
      was a retrospective analysis of a prospectively maintained database from a 
      tertiary referral center. We included all consecutive RAAA patients who underwent 
      open repair from 1990 to 2011. Univariate and multivariate analyses were used to 
      identify predictors of inferior short- and long-term outcomes. RESULTS: Overall, 
      463 patients were identified, of whom 138 (30%) were octogenarians (group 2), 
      with a mean age of 84 +/- 0.47 years. There were 96 (69%) men and 42 women (31%). 
      There were more women in group 2 (31%) compared with the <80-year-old patients of 
      group 1 (14%) (P < 0.001). The 30-day mortality for group 2 was 43.5% compared 
      with 28.0% for group 1 (P < 0.001). Preoperatively, 63% of group 1 patients 
      presented with shock compared with 65% of those in group 2 (P = 0.751). There was 
      no difference between the two groups in terms of preoperative systolic blood 
      pressure (SBP), duration of operation, and intraoperative blood loss (P > 0.05). 
      Median preoperative hemoglobin (P < 0.001) and creatinine (P = 0.031) levels were 
      significantly different between the groups. There was no significant difference 
      between the two groups in terms of postoperative complications and length of 
      hospital stay. Median long-term survival for octogenarians (group 2) was 5.4 
      years compared with 12.4 years for the younger patient group (group 1) (P < 
      0.001). Multivariate analysis identified age as an independent predictor of 
      30-day mortality (odds ratio [OR] = 1.154, 95% confidence interval [CI] 
      1.037-1.285) and inferior long-term survival (OR = 1.074, 95% CI 1.011-1.141). 
      History of cigarette smoking also predicted worse long-term outcomes (OR = 3.044, 
      95% CI 1.318-7.032) as did multiorgan failure in the postoperative course (OR = 
      1.363, 95% CI 1.080-14.130). CONCLUSIONS: Advanced age is associated with high 
      surgical mortality; however, for octogenarians surviving surgical repair, 
      long-term outcome is acceptable. Therefore, with responsible decision-making, 
      surgical intervention is justifiable in the elderly. Smoking and multiorgan 
      failure were both predictive of worse survival.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Barakat, Hashem M
AU  - Barakat HM
AD  - Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, 
      Hull, UK. Electronic address: hashem.barakat@gmail.com.
FAU - Shahin, Yousef
AU  - Shahin Y
AD  - Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, 
      Hull, UK.
FAU - Barnes, Rachel
AU  - Barnes R
AD  - Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, 
      Hull, UK.
FAU - Chetter, Ian
AU  - Chetter I
AD  - Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, 
      Hull, UK.
FAU - McCollum, Peter
AU  - McCollum P
AD  - Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, 
      Hull, UK.
LA  - eng
PT  - Journal Article
DEP - 20131105
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Aneurysm, Abdominal/diagnosis/mortality/*surgery
MH  - Aortic Rupture/diagnosis/mortality/*surgery
MH  - Chi-Square Distribution
MH  - England
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Length of Stay
MH  - Logistic Models
MH  - Male
MH  - Multiple Organ Failure/etiology/mortality
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Postoperative Complications/etiology
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Smoking/adverse effects/mortality
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Vascular Surgical Procedures/adverse effects/mortality
EDAT- 2013/11/10 06:00
MHDA- 2014/08/12 06:00
CRDT- 2013/11/09 06:00
PHST- 2013/03/05 00:00 [received]
PHST- 2013/06/12 00:00 [revised]
PHST- 2013/07/09 00:00 [accepted]
PHST- 2013/11/09 06:00 [entrez]
PHST- 2013/11/10 06:00 [pubmed]
PHST- 2014/08/12 06:00 [medline]
AID - S0890-5096(13)00393-2 [pii]
AID - 10.1016/j.avsg.2013.07.006 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2014 Jan;28(1):80-6. doi: 10.1016/j.avsg.2013.07.006. Epub 2013 
      Nov 5.