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Carotid endarterectomy in octogenarians
Raphael Varghese1, Paul Norman
1School of Surgery and Pathology, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia. raphaelvarghese@yahoo.com.au
ANZ Journal of Surgery
|March 27, 2004
Summary
Carotid endarterectomy is increasingly performed in octogenarians, with a rising proportion undergoing the procedure. Early outcomes show a slightly higher, though not statistically significant, stroke and death rate in this age group.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Clinical Outcomes Research
Background:
- Carotid endarterectomy (CEA) evidence is limited for octogenarians (80+ years) due to their exclusion from major trials.
- Understanding CEA trends and outcomes in the elderly is crucial for surgical decision-making.
Purpose of the Study:
- To analyze trends in CEA procedures among octogenarians.
- To evaluate the early outcomes of CEA in octogenarians at a single institution.
Main Methods:
- Retrospective review of 359 CEAs performed between 1990-2001.
- Analysis of procedure numbers, length of stay, patient age, and early outcomes.
- Separate analysis of outcomes for octogenarian patients.
Main Results:
- The proportion of octogenarians undergoing CEA significantly increased (P=0.03) over the study period.
- The combined stroke and death rate was 8.8% in octogenarians versus 5.8% in younger patients (P=0.59).
- Mean patient age increased, while length of stay decreased during the study.
Conclusions:
- The use of carotid endarterectomy in octogenarians has notably increased.
- While outcomes in octogenarians were not statistically worse, careful patient selection remains essential.