Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014
(2017) In European Journal of Vascular and Endovascular Surgery 53(5). p.656-662- Abstract
Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared... (More)
Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR). Results: Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences (p = .204 and p = .134). When rAAA patients were categorized into age groups (80-84 years, 85-89 years, 90+) crude survival diminished with increasing age, but long-term survival was not (p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR (p = .007), hazard ratio 1.3 (95% CI 1.1-1.6, p < .012). Conclusions: There is a high (50%) peri-operative mortality after surgery for rAAA in octo- and nonagenarians, with no significant differences between the sexes and worse survival with increasing age. However, if a patient has survived the initial 90 days, long-term survival in this very old cohort is surprisingly good at more than 50% after 5 years, only slightly less than the general population.
(Less)
- author
- Sonesson, B. LU ; Björses, K. LU ; Dias, N. LU ; Rylance, R. LU ; Mani, K. ; Wanhainen, A. and Resch, T. LU
- publishing date
- 2017-03-27
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Endovascular aneurysm repair, Octo- and nonagenarians, Open repair, Outcome, Ruptured abdominal aortic aneurysm
- in
- European Journal of Vascular and Endovascular Surgery
- volume
- 53
- issue
- 5
- pages
- 656 - 662
- publisher
- Elsevier
- external identifiers
-
- pmid:28356210
- scopus:85016006126
- ISSN
- 1078-5884
- DOI
- 10.1016/j.ejvs.2017.02.010
- language
- English
- LU publication?
- no
- id
- 4d724162-14d7-46d6-a751-a3fd5583c630
- date added to LUP
- 2017-04-19 13:34:30
- date last changed
- 2024-06-23 15:29:56
@article{4d724162-14d7-46d6-a751-a3fd5583c630, abstract = {{<p>Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR). Results: Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences (p = .204 and p = .134). When rAAA patients were categorized into age groups (80-84 years, 85-89 years, 90+) crude survival diminished with increasing age, but long-term survival was not (p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR (p = .007), hazard ratio 1.3 (95% CI 1.1-1.6, p < .012). Conclusions: There is a high (50%) peri-operative mortality after surgery for rAAA in octo- and nonagenarians, with no significant differences between the sexes and worse survival with increasing age. However, if a patient has survived the initial 90 days, long-term survival in this very old cohort is surprisingly good at more than 50% after 5 years, only slightly less than the general population.</p>}}, author = {{Sonesson, B. and Björses, K. and Dias, N. and Rylance, R. and Mani, K. and Wanhainen, A. and Resch, T.}}, issn = {{1078-5884}}, keywords = {{Endovascular aneurysm repair; Octo- and nonagenarians; Open repair; Outcome; Ruptured abdominal aortic aneurysm}}, language = {{eng}}, month = {{03}}, number = {{5}}, pages = {{656--662}}, publisher = {{Elsevier}}, series = {{European Journal of Vascular and Endovascular Surgery}}, title = {{Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014}}, url = {{http://dx.doi.org/10.1016/j.ejvs.2017.02.010}}, doi = {{10.1016/j.ejvs.2017.02.010}}, volume = {{53}}, year = {{2017}}, }