Surgical treatment of ruptured abdominal aortic aneurysms in the elderly

The aims of this study were to investigate current results of surgical treatment for elderly patients with ruptured abdominal aortic aneurysms (AAA) and to define factors associated with mortality. The study included 112 patients aged 75 years or older who were operated on for a ruptured AAA. The surgeries took place from January 1995 to December 1996 in 21 hospitals in Spain. Variables that could be related to death were retrospectively analyzed by entering data into SPSS statistical software. These variables included sex, age, diabetes, hypertension, cardiopathy, pulmonary obstructive disease, renal dysfunction, symptomatic cerebrovascular disease, peripheral occlusive disease, peripheral aneurysms, hematocrit on admission, preoperative hypotension, loss of consciousness, cardiac arrest, AAA location, aneurysm size, type of rupture, place of aortic cross-clamping, type of graft, use of cell saver, technical complications, intraoperative blood loss, and transfusion requirements. Postoperative complications were also considered, including renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation. For univariate statistical analysis, the Student's t-test, Mann-Whitney test, and chi-square test were used. Those variables showing statistical significance were entered into a multivariate logistic regression model. The results of these analyses indicate that in elderly patients undergoing surgery for ruptured AAA have a high operative mortality. Comorbid factors, however, were not identified as independent predictors of death. Surgery should not be denied these patients and selective screening should be contemplated.