Blunt traumatic aortic injury in the elderly population

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Geriatric Trauma

Background:

• Blunt thoracic aortic injury (BTAI) is a significant cause of death in trauma patients.
• Outcomes in elderly patients with BTAI differ due to unique injury patterns and contributing factors.
• Limited data exists on the presentation and management of BTAI specifically in the elderly population.

Purpose of the Study:

• To describe the patterns of presentation and management of BTAI in elderly patients (65 years and older).
• To analyze in-hospital mortality rates associated with different management strategies for BTAI in the elderly.
• To compare the effectiveness of thoracic endovascular aortic repair (TEVAR), open repair, and nonoperative management in this demographic.

Main Methods:

• Utilized the American College of Surgeons Trauma Quality Improvement Program database (2007-2016).
• Identified 1322 elderly patients (≥65 years) with BTAI who survived triage.
• Employed an adjusted Poisson generalized regression model with inverse probability of treatment weighting to compare mortality rates.

Main Results:

• The majority of elderly BTAI patients (69.1%) were managed nonoperatively.
• In-hospital mortality for the entire cohort was 37.9%.
• Adjusted analysis revealed TEVAR was associated with the lowest mortality rate (1.31 deaths/100 person-years) compared to open repair (2.53) and nonoperative management (3.91).
• Higher incidence of acute kidney injury, ARDS, and surgical site infection observed in the TEVAR group.

Conclusions:

• Nonoperative management of BTAI in the elderly is common but associated with higher mortality.
• TEVAR demonstrated a significantly lower in-hospital mortality rate compared to open repair and nonoperative management in elderly patients with BTAI.
• Despite increased risks of certain complications, TEVAR represents a potentially life-saving intervention for BTAI in the elderly.