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Carotid endarterectomy in elderly patients: low complication rate with overnight stay
Jihad R Salameh1, Jeffrey L Myers, Dipankar Mukherjee
1Department of Surgery, Inova Fairfax Hospital, Va, USA.
Hypothesis:
Elderly patients undergoing carotid endarterectomy (CEA) can have a low complication rate and a short hospital stay.
Design:
In this case series, we compared CEA results from January 1, 1994, through December 31, 1998, in 2 different age groups: 71 to 80 years and 81 years and older.
Setting:
A private vascular surgery practice.
Patients:
We studied 271 patients who underwent 293 CEAs; 124 procedures were for patients in the 71- to 80-year-old age group, and 42 procedures were for patients aged 81 years and older.
Interventions:
Classic CEA was performed on all patients. From 1994 through 1996, 179 operations were performed under general anesthesia with routine shunting. In 1997 and 1998, 114 operations were performed under locoregional anesthesia with selective shunting.
Main Outcome Measures:
Length of hospital stay and 30-day morbidity and mortality.
Results:
The mortality rate for the entire series was 0.7% (2 of 293 patients). Major cardiac complications occurred in 3 patients (1.0%). Perioperative stroke occurred in 3 cases(1.0%); 2 strokes occurred in patients aged 71 to 80 years (2 [1.6%] of 124 patients), and 1 occurred in a patient aged 81 years or older (1 [2.4%] of 42 patients). Two additional patients developed reversible ischemic neurological deficits but were not in the elderly group (> or =81 years and older). The mean hospital stay was 1.5 days for patients aged 71 to 80 years and 1.2 days for patients aged 81 years and older. All outcome variables were statistically similar in both age groups.
Conclusion:
Octogenarians can undergo CEA with little morbidity and mortality and virtually an overnight hospital stay.