Open repair of ruptured abdominal aortic aneurysm in patients aged 80 years and older.

Abstract

Open repair of ruptured abdominal aortic aneurysm (RAAA) in patients aged 80 years and older may be questioned owing to the patients' high operative risk and short life expectancy. Data on patients aged at least 80 years, admitted for RAAA at four Finnish university hospitals, were collected and analysed retrospectively. Three hundred and ten consecutive patients aged 80 years and older with RAAA reached hospital alive; 200 (64·5 per cent) underwent open repair. The number of open repairs increased during the last 5 years (49·0 per cent of the whole series), with no significant increase in the number of patients treated conservatively. The overall in-hospital mortality rate was 72·9 per cent. The operative mortality rate was 59·0 per cent and decreased from 66 to 52 per cent during the last 5 years (P = 0·050). On multivariable analysis, shock was the only independent predictor of immediate postoperative death (odds ratio 4·97, 95 per cent confidence interval 2·09 to7·94; P < 0·001). Classification and regression tree analysis showed that preoperative haemoglobin level and presence of shock were predictive of immediate postoperative death; 19 (95 per cent) of 20 patients with shock and a haemoglobin level below 68 g/l died immediately after surgery. Among the 82 survivors of surgery, survival rates at 1, 3 and 5 years were 90, 68 and 45 per cent respectively. These values were not significantly different from those of the age-, sex- and year-matched general population (P = 0·885). Survival after open repair of RAAA among patients aged 80 years and older is sufficient to justify the procedure, particularly in patients in a stable haemodynamic condition.