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Contemporary National Trends In Major Vascular Surgery Operations Among Octogenarians
Mohammad H. Eslami, MD, MPH, MBA
1, Samuel B. Booth, MD
1, Jeffrey J. Siracuse, MD, MBA
2, Scott Dean, PhD
1, Frank H. Annie, PhD
1, Ryan Butcher, MS
1.
1Charleston Area Medical Center, Charleston, WV, USA,
2Boston University School of Medicine, Boston, MA, USA.
Objective: Complex vascular surgery operations have become more commonplace in an aging population. We aimed to evaluate the trends in utilization and outcomes of octogenarians undergoing lower extremity bypass (LEB), carotid endarterectomy (CE) or abdominal aorta repair (AAAr).
Methods: The most recent non-COVID-19 National Inpatient Sample (NIS) databases were queried to include patients undergoing these operations. For each patient a Charleson Comorbidity Index (CCI) was calculated. We evaluated the trend of proportion of these procedures performed on the octogenarians and trends of CCI, type of admission, and in-hospital mortality (POD) among the octogenarians.
Results: From 2003-2019, there has been a significant change in the national proportion of vascular surgery patients who were octogenarians: a significantly higher percentage of AAAr were octogenarians whereas that proportion decreased for LEB or CE decreased (all p values <0.001). Overall, a minority of the octogenarian’s sample was female with an annual significant decrease in female: male ratio of octogenarians undergoing LEB or CE but no significant change in the female: male ratio amongst AAAr patients (2003: 25.02% vs. 2019: 25.31%, p=.30). Annually, the majority of all octogenarian patients were admitted electively without any discernable trends. For all operations, CCI of octogenarians significantly increased during the study period (Figure 2). Despite this observation, POD for all procedures decreased (Figure 3). Utilization of endovascular AAAr (EVAR) significantly increased among octogenarians.
Conclusions: Despite an aging population, the proportion of octogenarians has only increased among AAAr patients. All octogenarians undergoing these selected operations have higher annual comorbidities but with decreasing POD trends. This observation may be due to higher utilization of EVAR among AAAr patients, but other factors play a role among other elderly patients. Identification of those other factors requires further studies to continue the trend of improved outcomes among elderly vascular surgery patients.
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