Carotid endarterectomy in octogenarians
Shaw-Hua Kueh1, Vicki Livingstone, Ian A Thomson
1University of Cork, Cork, Ireland.
The New Zealand Medical Journal
|December 18, 2012
Summary
Older patients (80+) undergoing carotid endarterectomy (CEA) face similar complication risks as younger patients. This study found no significant difference in overall postoperative complications, suggesting age alone is not a barrier to CEA safety.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Surgical Outcomes Research
Background:
- Carotid endarterectomy (CEA) is a crucial procedure for preventing stroke in patients with symptomatic carotid artery stenosis.
- The safety and efficacy of CEA in elderly populations, particularly octogenarians, require thorough investigation due to potential increased perioperative risks.
Purpose of the Study:
- To compare the postoperative complication rates between patients aged 80 years or older and those younger than 80 undergoing carotid endarterectomy.
- To determine if advanced age is an independent risk factor for increased complications following this procedure.
Main Methods:
- A retrospective analysis of 1682 patients who underwent carotid endarterectomy between 1997 and 2005, identified from the New Zealand Vascular Surgical Audit Registry.
- Patients were stratified into two groups: age 80 or older (n=243) and younger than 80.
- Complication rates and baseline demographics were compared using Chi-squared tests, with logistic regression used for adjusting confounding factors.
Main Results:
- No significant difference in overall postoperative complication rates was observed between the older (≥80 years) and younger (<80 years) patient groups (17.2% vs. not specified, P=0.268).
- While younger patients were more likely to be male and diabetic, older patients were more frequently symptomatic from carotid stenosis.
- The cardiac complication rate was higher in octogenarians (4.5%) compared to younger patients (2.2%, P=0.035), though the overall combined death, TIA, and stroke rate was 3.3% for all patients.
Conclusions:
- Advanced age (80 years and older) is not associated with a significantly higher risk of overall perioperative complications following carotid endarterectomy.
- While cardiac complications showed a trend towards being higher in octogenarians, the overall risk profile remains acceptable, supporting the consideration of CEA in this demographic.
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