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Community hospital carotid endarterectomy in patients over age 75
J G Maxwell1, E J Rutherford, D L Covington
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill.
Insights
Older patients (75+) undergoing carotid endarterectomy (CE) face similar stroke and death risks as younger patients. Age is not a contraindication for this vascular surgery procedure.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Disease
Background:
- Carotid endarterectomy (CE) is a common procedure to prevent stroke.
- The safety of CE in elderly patients (75 and older) is a significant clinical concern.
- Limited data exists comparing outcomes in octogenarians versus younger individuals.
Purpose of the Study:
- To compare the incidence of stroke and death after carotid endarterectomy (CE) in patients aged 75 and older versus those younger than 75.
- To determine if advanced age is an independent risk factor for adverse outcomes following CE.
- To evaluate the safety and efficacy of CE in an elderly population.
Main Methods:
- Retrospective comparison of 133 patients aged 75+ (170 CE) and 501 patients <75 (640 CE).
- Outcomes analyzed included stroke and mortality rates.
- Logistic regression analysis controlled for comorbidities (diabetes, prior stroke, angina, etc.).
Main Results:
- Stroke rates were 2% in the 75+ group and 1% in the younger group (p=0.7).
- Mortality rates were 5% in the 75+ group and 2% in the younger group (p=0.1).
- After adjusting for confounders, age was not a significant predictor of stroke or death.
Conclusions:
- Age alone is not a contraindication for carotid endarterectomy (CE).
- Elderly patients (75+) can undergo CE with comparable safety to younger patients.
- Community hospitals can safely perform CE in older populations.
Abstract:
We compared the prevalence of stroke and death in 133 patients aged 75 and older in whom 170 carotid endarterectomies were performed with that in 501 patients less than age 75 in whom 640 carotid endarterectomies were performed. There were three strokes (2%) in patients aged 75 and older and nine strokes (1%) in younger patients (p = 0.7). There were 8 deaths (5%) in patients aged 75 and older and 14 deaths (2%) in younger patients (p = 0.1). After controlling for the possible confounding effects of diabetes, prior stroke, history of angina, prior carotid artery disease, previous vascular surgery, history of myocardial infarction, preoperative hypertension requiring medication, and female gender, a logistic regression model showed that patients aged 75 and older were no more likely to have a stroke or death than patients under age 75. We conclude that age alone is not a contraindication to the safe performance of carotid endarterectomy in the community hospital.