Operative morbidity and mortality in octogenarians after carotid endarterectomy: a propensity score matching study

Carotid endarterectomy remains the most effective surgical treatment for reducing the risk of stroke in patients with significant carotid stenosis. In fact, endovascular approach is associated with a higher incidence of perioperative and long-term minor stroke when compared to carotid endarterectomy although long-term functional outcome and risk of major stroke are similar. However, advanced age resulted to be associated with an increased risk of complications after carotid endarterectomy. Therefore, we decided to evaluate the outcome of carotid endarterectomy in octogenarians in our high-volume center.

Data of all patients who underwent CEA between June 2009 and December 2014 were retrospectively recorded. Patients were categorized as aged <80 or ≥80 years. Propensity score matching based on baseline clinical variables was performed to correct for any bias. Primary outcome was the difference in combined stroke and death. Secondary outcomes included incidence of myocardial infarction, surgical reintervention, unplanned intensive care unit admission and length of hospital stay.

A total of 2463 carotid endarterectomies were performed, including 439 patients aged ≥80 years. After propensity score adjustment all octogenarians were matched one-to-one to younger patients. No differences in combined stroke and death were found (1.10% in octogenarians vs. 0.46% in younger patients; P=0.45). Octogenarians had an increased length of hospital stay when compared to younger patients (3.1±0.7 vs. 3.4±1.3 days; P=0.0001). No differences in other secondary outcomes were found.

Age ≥80 years does not entail an increased perioperative risk after carotid endarterectomy. Hence, surgical carotid revascularization in octogenarians can be regarded as a safe and viable alternative to best medical therapy alone when performed in high-volume centers.