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Mortality after elective abdominal aortic aneurysm repair.
Felix J V Schlösser1, Ilonca Vaartjes, Geert J M G van der Heijden
1Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, CT, USA.
Annals of Surgery
|October 20, 2009
Summary
Mortality risks following elective abdominal aortic aneurysm (AAA) repair significantly increase with age and differ between genders. These factors, along with comorbidities, are crucial for surgical decision-making.
Area of Science:
- Vascular Surgery
- Public Health
- Epidemiology
Background:
- Elective abdominal aortic aneurysm (AAA) repair involves balancing surgical risks against the natural history of the condition.
- Existing literature lacks detailed mortality risk data stratified by both age and gender after elective AAA repair.
Purpose of the Study:
- To determine precise age- and gender-specific mortality risks for patients undergoing elective abdominal aortic aneurysm (AAA) repair.
- To inform clinical decision-making by providing granular risk stratification data.
Main Methods:
- Utilized a nationwide cohort of patients hospitalized for elective AAA repair between 1997 and 2000.
- Linked the Hospital Discharge Register with the Dutch Population Register to form the study cohort.
- Employed Cox regression analysis to identify demographic and medical history factors associated with mortality.
Main Results:
- The study included 3457 patients (86% male, mean age 72 years).
- Mortality risks escalated with age; 28-day mortality ranged from 3.3% (men) to 54.3% (women), and 5-year mortality from 12.9% (men) to 91.3% (women).
- Independent risk factors for 5-year mortality included advanced age, congestive heart failure, cerebrovascular disease, and diabetes mellitus.
Conclusions:
- Mortality following elective AAA repair is strongly correlated with patient age.
- Age, gender, and the presence of comorbidities are critical considerations in the surgical decision-making process for AAA repair.
- A standardized surgical threshold (e.g., 55 mm) may not be universally appropriate for all patients.
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