Safety and Feasibility of Vascular Surgical Procedures in Nonagenarians in the Era of Increasing Life Expectancy and Advanced Aging
Saqib Zia, MD, FACS, RPVI, Zachary Chadnick, MD, Amandeep Juneja, MD, Faez Ayoob, MD, Beenish Faheem, MS4.
Staten Island University Hospital Northwell Health, Staten Island, NY, USA.
Objective
With advances in minimally invasive techniques and increasing life expectancy, surgical procedures are being performed more frequently on older patients. The safety and risk profile for vascular procedures in nonagenarians is not well established. We present the outcomes review of all vascular procedures performed on nonagenarians at our institution.
Methods
We performed a retrospective review of nonagenarians who underwent vascular procedures from January 2014 to June 2017. Primary outcome was in hospital mortality and secondary outcomes were complications, length of hospital and ICU stay, readmission, return to the operating room and disposition.
Results
68 patients over the age of 90 years had vascular procedures. Mean age was 92 ±2 years and 58(85%) were females (table 1). 37(54%) lower extremity angiograms with or without revascularization, 20(29%) inferior vena cava filters, 6(9%) lower extremity bypasses, 1 endovascular abdominal aneurysm repair, 1 carotid endarterectomy, 1 dialysis access, 1 amputation and 1 debridement. 6 (9%) cases were emergent, 41 (60%) semi-elective and 21 (31%) elective. The in hospital mortality rate was 3%(2). 6(9%) patients received general anesthesia and all were extubated in the operating room. The most common complications were major adverse limb events (MALE) 5(7%) and hematomas 5(7%) followed by urinary tract infection 3(4%), acute kidney injury 3(4%), major adverse cardiac events (MACE) 3(4%), wound infection 2(3%) and unexpected return to the operating room 2(3%). 35(51%) patients had no complications. The mean hospital stay was 13±2.6 days. 12(18%) patients had ICU admissions post-operatively, with mean ICU stay of 2±2days. There were 8(12%) thirty-day readmissions. 35(51%) patients were discharged home, 14(21%) patients were discharged to a nursing facility for the first time and 17(26%) returned to their nursing facility after the procedure.
Conclusions
Vascular procedures in the nonagenarians appear to be safe with acceptable short-term perioperative outcomes. Interventions should be offered to functional and otherwise low and medium risk nonagenarians to meet the unmet needs of this subset of patients.
| DEMOGRAPHICS | |||||
| Mean Age, years | 92 ±2 | ||||
| Hypertension | 59 (87%) | ||||
| Dyslipidemia | 30 (44%) | ||||
| Diabetes Mellitus | 23 (34%) | ||||
| Chronic Kidney Disease | 26 (38%) | ||||
| Malignancy | 14 (21%) | ||||
| Peripheral Vascular Disease | 42 (62%) | ||||
| Coronary Artery Disease | 25 (37%) | ||||
| Congestive heart failure | 24 (35%) | ||||
| Atrial Fibrillation | 18 (26%) | ||||
| History of stroke | 15 (22%) | ||||
| OUTCOMES | Overall (68) | Angiograms (37) | Bypasses (6) | IVC Filters (20) | Others - EVAR, CEA etc. (5) |
| Major Adverse Cardiac Event | 3 (4%) | 2(5%) | 0(0%) | 1(5%) | 0(0%) |
| Major Adverse Limb Event | 5 (7%) | 5(13.5%) | 0(0%) | 0(0%) | 0(0%) |
| Hematoma | 5 (7%) | 5(13.5%) | 0(0%) | 0(0%) | 0(0%) |
| Wound Infection | 2 (3%) | 2(5%) | 0(0%) | 0(0%) | 0(0%) |
| Urinary Tract Infection | 3 (4%) | 2(5%) | 0(0%) | 1(5%) | 0(0%) |
| Acute Kidney Injury | 3 (4%) | 3(8%) | 0(0%) | 0(0%) | 0(0%) |
| Atrial Fibrillation | 1 (2%) | 0(0%) | 0(0%) | 1(5%) | 0(0%) |
| Return to the OR | 2 (3%) | 1(3%) | 1(17%) | 0(0%) | 0(0%) |
| Readmission | 8 (12%) | 5(13.5%) | 1(17%) | 1(5%) | 1(20%) |
| No Complications | 35 (51%) | 15(41%) | 4(67%) | 12(60%) | 4(80%) |
| In Hospital Mortality | 2 (3%) | 1(3%) | 0(0%) | 1(5%) | 0(0%) |
Table 1- Demographics and Procedure Based Outcomes
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