Cor Vasa 2013, 55(5):e439-e444 | DOI: 10.1016/j.crvasa.2013.05.003

Open repair of Abdominal Aortic Aneurysm in the elderly: Is it worthwhile?

Jitka Mannováa,b,*, Zdeněk Šilhartc, Jiří Machd, Pavel Ševčíke, Aleš Prokešf
a Klinika anesteziologie a intenzivní medicíny, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika
b Anesteziologicko-resuscitační oddělení, Nemocnice Havlíčkův Brod, Havlíčkův Brod, Česká republika
c Chirurgická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika
d Oddělení anesteziologie a resuscitace, Nemocnice v Mistelbachu, Mistelbach, Rakousko
e Anesteziologicko-resuscitační klinika, Fakultní nemocnice Ostrava, Ostrava, Česká republika
f Fakulta elektrotechniky a komunikačních technologií, Vysoké učení technické, Brno, Česká republika

Introduction: Given the steady increase in life expectancy, an analysis of surgical outcomes in the aging population is of significant interest to vascular surgeons. The aim of our study was to assess the outcomes of abdominal aortic aneurysm repair in the elderly aged 75 plus and compare their results with people operated on at a younger age.

Methods: 171 patients who underwent open AAA repair in one centre in 1999-2008 were analyzed. The perioperative and postoperative complications, 30-day mortality, the length of ICU and hospital stay were compared, and the Kruskal-Wallis and the Chi-square tests were used for statistical analysis.

Results: There were no statistically significant differences in gender and patients' preoperative comorbidities except for ICHS and CHRI which were more frequent in the elderly 75 plus. The frequency of serious perioperative haemodynamic complications and postoperative (cardiac, respiratory, cerebral, bleeding, sepsis, surgical) complications, mortality rate and the length of hospital stay did not significantly differ in the elderly 75 plus. A statistically significant difference was found only in the frequency of postoperative renal damage and the length of ICU stay. The elderly 75 plus without enhanced haemodynamic monitoring had significantly longer ICU stay (5 days vs. 7 days, p

Keywords: AAA repair; Complications; ICU and hospital stay; Mortality; The elderly

Received: December 16, 2012; Revised: May 5, 2013; Accepted: May 17, 2013; Published: October 1, 2013  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Mannová J, Šilhart Z, Mach J, Ševčík P, Prokeš A. Open repair of Abdominal Aortic Aneurysm in the elderly: Is it worthwhile? Cor Vasa. 2013;55(5):e439-444. doi: 10.1016/j.crvasa.2013.05.003.
Download citation

References

  1. P.J. Geraghty, G.A. Sicard, Abdominal aortic aneurysm repair in high-risk and elderly patients, Journal of Cardiovascular Surgery 44 (2003) 543-547.
  2. A. Dardik, J.W. Lin, T.A. Gordon, et al., Results of elective abdominal aneurysm repair in the 1990s: a population based analysis of 2335 cases, Journal of Vascular Surgery 30 (1999) 985-995. Go to original source... Go to PubMed...
  3. P.S. Paty, W.E. Lloyd, B.B. Chang, et al., Aortic replacement for abdominal aortic aneurysm in elderly patients, American Journal of Surgery 166 (1993) 191-193. Go to original source... Go to PubMed...
  4. A. Kazmers, A.J. Perkins, L.A. Jacobs, Outcomes after abdominal aortic aneurysm repair in those > or =80 years of age: recent Veterans Affair experience, Annals of Vascular Surgery 12 (1998) 106-112. Go to original source... Go to PubMed...
  5. R. Mailapur, A.M. Yousuf, T. Girishkumar, et al., A decade of experience with abdominal aortic aneurysm in octogenerians, Journal of Cardiovascular Surgery 42 (2001) 525-528.
  6. S.E. Noblett, C.P. Snowden, B.K. Shenton, A.F. Horgan, Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection, British Journal of Surgery 93 (2006) 1069-1076. Go to original source... Go to PubMed...
  7. H.D. Wakeling, M.R. McFall, C.S. Jenkins, et al., Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery, British Journal of Anaesthesia 95 (2005) 634-642. Go to original source... Go to PubMed...
  8. M.R. McFall, W.G. Woods, H.G. Wakelign, The use of oesophageal Doppler cardiac output measurement to optimize fluid management during colorectal surgery, European Journal of Anaesthesiology 21 (2004) 581-583. Go to original source...
  9. M. McKendry, H. McGloin, D. Saberi, et al., Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery, British Medical Journal 329 (2004) 258-261. Go to original source... Go to PubMed...
  10. R. Venn, A. Steele, P. Richardson, et al., Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures, British Journal of Anaesthesia 88 (2002) 65-71. Go to original source... Go to PubMed...
  11. T.J. Gan, A. Soppit, M. Maroof, et al., Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery, Anaesthesiology 97 (2002) 820-826. Go to original source... Go to PubMed...
  12. D.H. Conway, R. Mayall, M.S. Abdul-Latif, et al., Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery, Anaesthesia 57 (2002) 845-849. Go to original source... Go to PubMed...
  13. I. Chytra, R. Pradl, R. Bosman, et al., Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial, Critical Care 11 (2007) R24. Go to original source... Go to PubMed...
  14. M.G. Mythen, A.R. Webb, Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery, Archives of Surgery 130 (1995) 423-429. Go to original source... Go to PubMed...
  15. S. Sincalir, S. James, M. Singer, Intraoperative intravascular volume optimization and length of hospital stay after repair of proximal femoral fracture: randomized controlled trial, British Medical Journal 315 (1997) 909-912. Go to original source... Go to PubMed...
  16. P. Schober, S.A. Loer, L.A. Schwarte, Perioperative hemodynamic monitoring with transeosophageal Doppler technology, Anesthesia and Analgesia 109 (2009) 340-353. Go to original source... Go to PubMed...
  17. P. Carmichael, A.R. Carmichael, Acute renal failure in the surgical setting, ANZ Journal of Surgery 73 (2003) 144-153. Go to original source... Go to PubMed...
  18. I. Tang, P.T. Murray, Prevention of perioperative acute renal failure: what works?, Best Practice & Research Clinical Anaesthesiology 18 (2004) 91-111. Go to original source... Go to PubMed...
  19. J.W. Kern, W.C. Schoemaker, Meta-analysis of hemodynamic optimization in high-risk patients, Critical Care Medicine 30 (2002) 1686-1692. Go to original source... Go to PubMed...
  20. N. Brienza, M.T. Giglio, M. Marucci, T. Fiore, Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study, Critical Care Medicine 37 (2009) 2079-2088. Go to original source... Go to PubMed...
  21. A. Jones, D. Cahill, R. Gardham, Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery, British Journal of Surgery 85 (1998) 1382-1384. Go to original source... Go to PubMed...
  22. K.P. Conway, J. Byrne, M. Townsend, I.F. Lane, Prognosis of patients turn down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era, Journal of Vascular Surgery 33 (2001) 752-757. Go to original source... Go to PubMed...
  23. D. Drury, J.A. Michaels, L. Jones, L. Ayiku, Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm, British Journal of Surgery 92 (2005) 937-946. Go to original source... Go to PubMed...
  24. G.A. Sicard, B.G. Rubin, L.A. Sanchez, et al., Endoluminal graft repair for abdominal aortic aneurysms in high-risk patients and octogenerians: is it better than open repair?, Annals of Surgery 234 (2001) 427-435. Go to original source...




Cor et Vasa

You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.