Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms
Authors: Alberga Anna J. , de Bruin Jorg L. , Bastos Gonçalves Frederico , Karthaus Eleonora G. , Wilschut Janneke A. , van Herwaarden Joost A. , Wever Jan J. , Verhagen Hence J. M. , PJ Van den Akker , GJ Akkersdijk , GP Akkersdijk , WL Akkersdijk , MG van Andringa de Kempenaer , CH Arts , JA Avontuur , OJ Bakker , R Balm , WB Barendregt , JA Bekken , MH Bender , BL Bendermacher , M van den Berg , P Berger , RJ Beuk , JD Blankensteijn , RJ Bleker , JJ Blok , AS Bode , ME Bodegom , KE van der Bogt , AP Boll , MH Booster , BL Borger van der Burg , GJ de Borst , WT Bos-van Rossum , J Bosma , JM Botman , LH Bouwman , V Brehm , MT de Bruijn , JL de Bruin , P Brummel , JP van Brussel , SE Buijk , MA Buijs , MG Buimer , DH Burger , HC Buscher , E Cancrinus , PH Castenmiller , G Cazander , AM Coester , PH Cuypers , JH Daemen , I Dawson , JE Dierikx , ML Dijkstra , J Diks , MK Dinkelman , M Dirven , DE Dolmans , RC van Doorn , LM van Dortmont , JW Drouven , MM van der Eb , D Eefting , GJ van Eijck , JW Elshof , BH Elsman , A van der Elst , MI van Engeland , RG van Eps , MJ Faber , WM de Fijter , B Fioole , TM Fokkema , FA Frans , WM Fritschy , PH Fung Kon Jin , RH Geelkerken , WB van Gent , GJ Glade , B Govaert , RP Groenendijk , HG de Groot , RF van den Haak , EF de Haan , GF Hajer , JF Hamming , ES van Hattum , CE Hazenberg , PP Hedeman Joosten , JN Helleman , LG van der Hem , JM Hendriks , JA van Herwaarden , JM Heyligers , JW Hinnen , RJ Hissink , GH Ho , PT den Hoed , MT Hoedt , F van Hoek , R Hoencamp , WH Hoffmann , W Hogendoorn , AW Hoksbergen , EJ Hollander , M Hommes , CJ Hopmans , LC Huisman , RG Hulsebos , KM Huntjens , MM Idu , MJ Jacobs , MF van der Jagt , JR Jansbeken , RJ Janssen , HH Jiang , SC de Jong , TA Jongbloed-Winkel , V Jongkind , MR Kapma , BP Keller , A Khodadade Jahrome , JK Kievit , PL Klemm , P Klinkert , NA Koedam , MJ Koelemaij , JL Kolkert , GG Koning , OH Koning , R Konings , AG Krasznai , RM Krol , RH Kropman , RR Kruse , L van der Laan , n MJ van der Laa , JH van Laanen , GW van Lammeren , DA Lamprou , JH Lardenoye , GJ Lauret , BJ Leenders , DA Legemate , VJ Leijdekkers , MS Lemson , MM Lensvelt , MA Lijkwan , RC Lind , FT van der Linden , PF Liqui Lung , MJ Loos , MC Loubert , KM van de Luijtgaarden , DE Mahmoud , CG Manshanden , EC Mattens , R Meerwaldt , BM Mees , GC von Meijenfeldt , TP Menting , R Metz , RC Minnee , JC de Mol van Otterloo , MJ Molegraaf , YC Montauban van Swijndregt , MJ Morak , RH van de Mortel , W Mulder , SK Nagesser , CC Naves , JH Nederhoed , AM Nevenzel-Putters , AJ de Nie , DH Nieuwenhuis , J Nieuwenhuizen , RC van Nieuwenhuizen , D Nio , VJ Noyez , AP Oomen , BI Oranen , J Oskam , HW Palamba , AG Peppelenbosch , AS van Petersen , BJ Petri , ME Pierie , AJ Ploeg , RA Pol , ED Ponfoort , IC Post , PP Poyck , A Prent , S ten Raa , JT Raymakers , M Reichart , BL Reichmann , MM Reijnen , JA de Ridder , A Rijbroek , MJ van Rijn , RA de Roo , EV Rouwet , BR Saleem , PB Salemans , MR van Sambeek , MG Samyn , HP van ‘t Sant , J van Schaik , PM van Schaik , DM Scharn , MR Scheltinga , A Schepers , PM Schlejen , FJ Schlosser , FP Schol , VP Scholtes , O Schouten , MA Schreve , GW Schurink , CJ Sikkink , Slaa A te , HJ Smeets , L Smeets , RR Smeets , AA de Smet , PC Smit , TM Smits , MG Snoeijs , AO Sondakh , MJ Speijers , TJ van der Steenhoven , SM van Sterkenburg , DA Stigter , RA Stokmans , RP Strating , GN Stultiëns , JE Sybrandy , JA Teijink , BJ Telgenkamp , M Teraa , MJ Testroote , T Tha-In , RM The , WJ Thijsse , I Thomassen , IF Tielliu , RB van Tongeren , RJ Toorop , E Tournoij , M Truijers , K Türkcan , RP Tutein Nolthenius , Ç Ünlü , RH Vaes , AA Vafi , AC Vahl , EJ Veen , HT Veger , MG Veldman , S Velthuis , HJ Verhagen , BA Verhoeven , CF Vermeulen , EG Vermeulen , BP Vierhout , RJ van der Vijver-Coppen , MJ Visser , JA van der Vliet , CJ Vlijmen—van Keulen , R Voorhoeve , JR van der Vorst , AW Vos , B de Vos , CG Vos , GA Vos , MT Voute , BH Vriens , PW Vriens , AC de Vries , DK de Vries , JP de Vries , M de Vries , C van der Waal , EJ Waasdorp , BM Wallis de Vries , LA van Walraven , JL van Wanroij , MC Warlé , W van de Water , V van Weel , AM van Well , GM Welten , RJ Welten , JJ Wever , AM Wiersema , OR Wikkeling , WI Willaert , J Wille , MC Willems , EM Willigendael , ED Wilschut , W Wisselink , ME Witte , CH Wittens , CY Wong , R Wouda , O Yazar , KK Yeung , CJ Zeebregts , ML van Zeeland 
Published: March 2022

Purpose: Octogenarians are known to have less-favorable outcomes following ruptured abdominal aortic aneurysm (rAAA) repair compared with their younger counterparts. Accurate information regarding perioperative outcomes following rAAA-repair is important to evaluate current treatment practice. The aim of this study was to evaluate perioperative outcomes of octogenarians and to identify factors associated with mortality and major complications after open surgical repair (OSR) or endovascular aneurysm repair (EVAR) of a rAAA using nationwide, real-world, contemporary data. Methods: All patients that underwent EVAR or OSR of an infrarenal or juxtarenal rAAA between January 1, 2013, and December 31, 2018, were prospectively registered in the Dutch Surgical Aneurysm Audit (DSAA) and included in this study. The primary outcome was the comparison of perioperative outcomes of octogenarians versus non-octogenarians, including adjustment for confounders. Secondary outcomes were the identification of factors associated with mortality and major complications in octogenarians. Results: The study included 2879 patients, of which 1146 were treated by EVAR (382 octogenarians, 33%) and 1733 were treated by OSR (410 octogenarians, 24%). Perioperative mortality of octogenarians following EVAR was 37.2% versus 14.8% in non-octogenarians (adjusted OR=2.9, 95% CI=2.8–3.0) and 50.0% versus 29.4% following OSR (adjusted OR=2.2, 95% CI=2.2–2.3). Major complication rates of octogenarians were 55.4% versus 31.8% in non-octogenarians following EVAR (OR=2.7, 95% CI=2.1–3.4), and 68% versus 49% following OSR (OR=2.2, 95% CI=1.8–2.8). Following EVAR, 30.6% of the octogenarians had an uncomplicated perioperative course (UPC) versus 49.5% in non-octogenarians (OR=0.5, 95% CI=0.4–0.6), while following OSR, UPC rates were 20.7% in octogenarians versus 32.6% in non-octogenarians (OR=0.5, 95% CI=0.4–0.7). Cardiac or pulmonary comorbidity and loss of consciousness were associated with mortality and major complications in octogenarians. Interestingly, female octogenarians had lower mortality rates following EVAR than male octogenarians (adjusted OR=0.7, 95% CI=0.6–0.8). Conclusion: Based on this nationwide study with real-world registry data, mortality rates of octogenarians following ruptured AAA-repair were high, especially after OSR. However, a substantial proportion of these octogenarians following OSR and EVAR had an uneventful recovery. Known preoperative factors do influence perioperative outcomes and reflect current treatment practice.