Back to 2016 Annual Symposium Abstacts

OBJECTIVES:
Octogenarians have been found to have an acceptable, yet increased, risk to undergo carotid endarterectomy (CEA) for carotid artery occlusive disease. The reasons for this increased risk have not been well described. We sought to identify if octogenarians have an increased risk of post-operative complications and to identify the predictors of those adverse outcomes after CEA.
METHODS:
The National Surgical Quality Improvement Program (NSQIP) database was queried, between 2005 and 2011, to identify patients who underwent CEA. There were a total of 44650 CEA procedures performed during this time. The patients were divided into an octogenarian (CEA-O) group and a non-octogenarian (CEA-NO) group. Patient demographics, comorbidities, perioperative data, and outcomes were compared.
RESULTS:
There were 9270 patients in the CEA-O group. Univariate analysis revealed that the CEA-NO group had more males (59.6% v. 57.5%, p <0.01), recent PCI (17.3% v. 15.2%, p<0.01), MI (1.4% v. 1.0%, p<0.01), COPD (11.1% v. 9.6%, p<0.01) renal failure (1.1% v. 0.7%, p<0.01) and diabetes (30% v. 21.6%, p<0.01). The CEA-O group more often had CHF (1.3% v 1%, p=0.03), recent TIA (28.3% v 23.9%, p<0.01) and asymptomatic stroke (9% v 8.1%, p<0.01). Post-operative cardiopulmonary complications were more common in the CEA-O group, including pneumonia (1.5% v 1.1%, p<0.01), reintubation (1.5% v 1.1%, p<0.01), MI (1.3% v 0.7%, p<0.01), 30-day mortality (1.3% v 0.6%, p<0.01) and combined stroke/death/MI (3.4% v 2.4%, p<0.01). Multivariate analysis identified pre-existing CHF, TIA, renal failure and recent stroke as predictors of stroke/death/MI after CEA in octogenarians. Table 1 lists relative odds ratios and p-values.
CONCLUSIONS:
Octogenerians have a higher rate of complications following CEA than younger patients despite a lower rate of significant pre-operative medical comorbidities. Pre-existing cardiopulmonary comorbidities and symptomatic carotid disease are independent predictors of stroke/death/MI after CEA in the elderly population.

Multivariate Regression Analysis with Independent Predictors of Stroke/Death/MI after CEA

Co-morbid Condition	Odds Ratio	95% Confidence Interval - Lower Bound	95% Confidence Interval - Upper Bound	p - Value
MI (within 6 months)	2.15	1.56	2.97	<0.01
COPD	1.43	1.22	1.67	<0.01
History of CVA with Neurologic Deficits	1.66	1.40	1.96	<0.01
Dialysis Dependence	1.79	1.22	2.64	<0.01