Predictors Of Mortality For Nonagenarians Undergoing Abdominal Aortic Aneurysm Repair: Analysis Of The NSQIP Dataset
Matthew Major, MD, Graham Long, MD, Elizabeth Gates, RN, Diane Studzinski, BS, Rose Callahan, MS, Robert Welsh, MD, O. William Brown, MD, JD.
Beaumont Health, Royal Oak, MI, USA.
Predictors of Mortality for Nonagenarians Undergoing Abdominal Aortic Aneurysm Repair: Analysis of the NSQIP Dataset
Introduction: This study utilized the American College of Surgeons National Surgical Quality Improvement Program dataset (ACS-NSQIP) to identify predictors of 30-day mortality for nonagenarians undergoing Endovascular (EVAR) and Open Aortic Aneurysm Repair (OSR).
Methods: Patients over age 90 years who had AAA repair from 2005-2017 were identified using procedure codes. Those with operative times shorter than 15 minutes were excluded. Demographics and outcomes of those who died within 30 days were compared to those alive at 30 days.
Results: One thousand three hundred and fifty six nonagenarians meeting criteria underwent AAA repair from 2005-2017. One thousand two hundred and twenty nine (90.6%) had EVAR and 127 (9.4%) had OSR. Overall 30-day mortality was 11.6%. Patients with 30-day mortality were statistically significantly more likely to have OSR, female gender, dependent functional status, higher ASA score, increased operative time, blood transfusion, pneumonia, unplanned intubation, mechanical ventilation >48 hrs, and acute renal failure. OSR had 30-day mortality rates of 19.1% for elective cases and 53.7% for emergent. EVAR had 30-day mortality rates of 2.6% for elective cases and 28.6% for emergent. In the EVAR cohort, dependent functional status, increased ASA score, increased operative time, blood transfusion, and emergency surgery were statistically significant risk factors for increased 30-day mortality.
Conclusion: Nonagenarians undergoing AAA repair had a higher mortality rate than that reported for the general population, particularly for OSR and emergent cases. However, nonagenarians having elective EVAR demonstrated 2.6% 30-day mortality, suggesting it is reasonable to offer EVAR using standard aneurysm criteria (5.0 and 5.5 cm). Those with poor functional status and increased ASA score had statistically higher 30-day mortality after EVAR.
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