Outcomes of suprainguinal bypass for aortoiliac occlusive disease in octogenarians: A Vascular Quality Initiative analysis.

Abstract

In an aging population with an increasing prevalence of aortoiliac occlusive disease, the management of octogenarians presents unique challenges due to higher rates of comorbidities and reduced physiological reserves. This study uses Vascular Quality Initiative data to evaluate the outcomes of suprainguinal bypass (SIB) in octogenarians. Patients aged 51 to 89 years old undergoing SIB for aortoiliac occlusive disease in the Vascular Quality Initiative database (2009-2023) were identified. Patients were stratified based on age category (octogenarians vs nonoctogenarians). The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications, postoperative reintervention, red blood cell transfusion, intensive care unit stay of >3 days, and 1-year mortality. Postoperative complications included myocardial infarction, respiratory complications, congestive heart failure, postoperative nonambulatory status, and surgical site infection. Logistic and Cox regressions were used for multivariate analyses. A Poisson spline model was used to show the 30-day mortality risk across patients aged 51 to 89 years. A total of 1397 octogenarians (7%) and 18,533 nonoctogenarians (93%) were included. Octogenarians had more severe comorbidities and were more likely to present with critical limb ischemia (56.1% vs 45.6%; P < .001). Octogenarians primarily underwent femorofemoral bypass (56%), axillofemoral bypass (36.6%), and aortofemoral/aortoiliac bypass (AFB/AIB) (7.4%), whereas nonoctogenarians predominantly underwent AFB/AIB (47.8%), femorofemoral bypass (32.8%), and axillofemoral bypass (19.4%). The 30-day mortality rate was higher in octogenarians compared with nonoctogenarians (9.3% vs 3.6%; P < .001). After adjusting for potential confounders, the octogenarian category remained associated with an increased risk of 30-day mortality (adjusted odds ratio [aOR], 1.99; 95% confidence interval [CI], 1.56-2.55; P < .001), myocardial infarction (aOR, 1.59; 95% CI, 1.18-2.14; P = .002), congestive heart failure (aOR, 1.46; 95% CI, 1.04-2.06; P = .028), nonambulatory status (aOR, 1.56; 95% CI, 1.24-1.97; P < .001), red blood cell transfusion (aOR, 1.16; 95% CI, 1.01-1.34; P = .039), and 1-year mortality (adjusted hazard ratio, 2.05; 95% CI, 1.78-2.36; P < .001). However, respiratory complications, surgical site infection, intensive care unit stay of >3 days, and reintervention were not affected by age category. The spline model demonstrated a significant association between age and the risk of 30-day mortality beginning at 59 years of age. A subanalysis of outcomes only in the octogenarian cohort revealed that extra-anatomical bypass was associated with a lower risk of 30-day mortality compared with AFB/AIB (aOR, 0.47; 95% CI, 0.25-0.88; P = .018). Octogenarians are at higher risk of 30-day and 1-year mortality, as well as postoperative cardiac complications, after SIB. In this population, extra-anatomical bypass is associated with a significant decrease in mortality and may represent a reasonable approach in selected high-risk patients.