Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

Anna J Alberga; Jorg L de Bruin; Frederico Bastos Gonçalves; Eleonora G Karthaus; Janneke A Wilschut; Joost A van Herwaarden; Jan J Wever; Hence J M Verhagen; Collaboration With the Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing

doi:10.1177/15266028221083460

Nationwide Outcomes of Octogenarians Following Open or Endovascular Management After Ruptured Abdominal Aortic Aneurysms

J Endovasc Ther. 2023 Jun;30(3):419-432. doi: 10.1177/15266028221083460. Epub 2022 Mar 21.

Authors

Anna J Alberga^{1

2}, Jorg L de Bruin¹, Frederico Bastos Gonçalves³, Eleonora G Karthaus⁴, Janneke A Wilschut², Joost A van Herwaarden⁵, Jan J Wever⁶, Hence J M Verhagen¹; Collaboration With the Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing

Collaborators

Collaboration With the Dutch Society of Vascular Surgery*, the Steering Committee of the Dutch Surgical Aneurysm Audit and the Dutch Institute for Clinical Auditing:
Van den Akker Pj, Akkersdijk Gj, Akkersdijk Gp, Akkersdijk Wl, van Andringa de Kempenaer Mg, Arts Ch, Avontuur Ja, Bakker Oj, Balm R, Barendregt Wb, Bekken Ja, Bender Mh, Bendermacher Bl, van den Berg M, Berger P, Beuk Rj, Blankensteijn Jd, Bleker Rj, Blok Jj, Bode As, Bodegom Me, van der Bogt Ke, Boll Ap, Booster Mh, Borger van der Burg Bl, de Borst Gj, Bos-van Rossum Wt, Bosma J, Botman Jm, Bouwman Lh, Brehm V, de Bruijn Mt, de Bruin Jl, Brummel P, van Brussel Jp, Buijk Se, Buijs Ma, Buimer Mg, Burger Dh, Buscher Hc, Cancrinus E, Castenmiller Ph, Cazander G, Coester Am, Cuypers Ph, Daemen Jh, Dawson I, Dierikx Je, Dijkstra Ml, Diks J, Dinkelman Mk, Dirven M, Dolmans DE, van Doorn Rc, van Dortmont Lm, Drouven Jw, van der Eb Mm, Eefting D, van Eijck Gj, Elshof Jw, Elsman Bh, van der Elst A, van Engeland Mi, van Eps Rg, Faber Mj, de Fijter Wm, Fioole B, Fokkema Tm, Frans Fa, Fritschy Wm, Fung Kon Jin Ph, Geelkerken Rh, van Gent Wb, Glade Gj, Govaert B, Groenendijk Rp, de Groot Hg, van den Haak Rf, de Haan Ef, Hajer Gf, Hamming Jf, van Hattum Es, Hazenberg Ce, Hedeman Joosten Pp, Helleman Jn, van der Hem Lg, Hendriks Jm, van Herwaarden Ja, Heyligers Jm, Hinnen Jw, Hissink Rj, Ho Gh, den Hoed Pt, Hoedt Mt, van Hoek F, Hoencamp R, Hoffmann Wh, Hogendoorn W, Hoksbergen Aw, Hollander Ej, Hommes M, Hopmans Cj, Huisman Lc, Hulsebos Rg, Huntjens Km, Idu Mm, Jacobs Mj, van der Jagt Mf, Jansbeken Jr, Janssen Rj, Jiang Hh, de Jong Sc, Jongbloed-Winkel Ta, Jongkind V, Kapma Mr, Keller Bp, Khodadade Jahrome A, Kievit Jk, Klemm Pl, Klinkert P, Koedam Na, Koelemaij Mj, Kolkert Jl, Koning Gg, Koning Oh, Konings R, Krasznai Ag, Krol Rm, Kropman Rh, Kruse Rr, van der Laan L, van der Laa N Mj, van Laanen Jh, van Lammeren Gw, Lamprou DA, Lardenoye Jh, Lauret Gj, Leenders Bj, Legemate DA, Leijdekkers Vj, Lemson Ms, Lensvelt Mm, Lijkwan Ma, Lind Rc, van der Linden Ft, Liqui Lung Pf, Loos Mj, Loubert Mc, van de Luijtgaarden Km, Mahmoud DE, Manshanden Cg, Mattens Ec, Meerwaldt R, Mees Bm, von Meijenfeldt Gc, Menting Tp, Metz R, Minnee Rc, de Mol van Otterloo Jc, Molegraaf Mj, Montauban van Swijndregt Yc, Morak Mj, van de Mortel Rh, Mulder W, Nagesser Sk, Naves Cc, Nederhoed Jh, Nevenzel-Putters Am, de Nie Aj, Nieuwenhuis Dh, Nieuwenhuizen J, van Nieuwenhuizen Rc, Nio D, Noyez Vj, Oomen Ap, Oranen Bi, Oskam J, Palamba Hw, Peppelenbosch Ag, van Petersen As, Petri Bj, Pierie Me, Ploeg Aj, Pol Ra, Ponfoort Ed, Post Ic, Poyck Pp, Prent A, Ten Raa S, Raymakers Jt, Reichart M, Reichmann Bl, Reijnen Mm, de Ridder Ja, Rijbroek A, van Rijn Mj, de Roo Ra, Rouwet Ev, Saleem Br, Salemans Pb, van Sambeek Mr, Samyn Mg, van 't Sant Hp, van Schaik J, van Schaik Pm, Scharn Dm, Scheltinga Mr, Schepers A, Schlejen Pm, Schlosser Fj, Schol Fp, Scholtes Vp, Schouten O, Schreve Ma, Schurink Gw, Sikkink Cj, Te Slaa A, Smeets Hj, Smeets L, Smeets Rr, de Smet Aa, Smit Pc, Smits Tm, Snoeijs Mg, Sondakh Ao, Speijers Mj, van der Steenhoven Tj, van Sterkenburg Sm, Stigter DA, Stokmans Ra, Strating Rp, Stultiëns Gn, Sybrandy Je, Teijink Ja, Telgenkamp Bj, Teraa M, Testroote Mj, Tha-In T, The Rm, Thijsse Wj, Thomassen I, Tielliu If, van Tongeren Rb, Toorop Rj, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius Rp, Ünlü Ç, Vaes Rh, Vafi Aa, Vahl Ac, Veen Ej, Veger Ht, Veldman Mg, Velthuis S, Verhagen Hj, Verhoeven Ba, Vermeulen Cf, Vermeulen Eg, Vierhout Bp, van der Vijver-Coppen Rj, Visser Mj, van der Vliet Ja, Vlijmen-van Keulen Cj, Voorhoeve R, van der Vorst Jr, Vos Aw, de Vos B, Vos Cg, Vos Ga, Voute Mt, Vriens Bh, Vriens Pw, de Vries Ac, de Vries Dk, de Vries Jp, de Vries M, van der Waal C, Waasdorp Ej, Wallis de Vries Bm, van Walraven LA, van Wanroij Jl, Warlé Mc, van de Water W, van Weel V, van Well Am, Welten Gm, Welten Rj, Wever Jj, Wiersema Am, Wikkeling Or, Willaert Wi, Wille J, Willems Mc, Willigendael Em, Wilschut Ed, Wisselink W, Witte Me, Wittens Ch, Wong Cy, Wouda R, Yazar O, Yeung Kk, Zeebregts Cj, van Zeeland Ml

Affiliations

¹ Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
² Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
³ Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de Lisboa Central, NOVA Medical School, Lisboa, Portugal.
⁴ Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁵ Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
⁶ Department of Vascular Surgery, Haga Teaching Hospital, The Hague, The Netherlands.

Abstract

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.

Keywords: abdominal aortic aneurysm; endovascular aneurysm repair; open surgical repair; registry; rupture.

MeSH terms

Aortic Aneurysm, Abdominal* / complications
Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Aortic Rupture* / diagnostic imaging
Aortic Rupture* / etiology
Aortic Rupture* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Procedures* / adverse effects
Female
Humans
Male
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Treatment Outcome