Outcomes following endovascular aortic aneurysm repair in nonagenarian patients.

Abstract

Endovascular aneurysm repair is the predominant modality for abdominal aortic aneurysm management, yet evidence guiding patient selection in nonagenarians remains limited. We examined perioperative outcomes following elective endovascular aneurysm repair in nonagenarian patients. The 2012-2021 American College of Surgeons National Surgical Quality Improvement Program was queried for patients ≥70 years undergoing elective endovascular aneurysm repair for nonruptured abdominal aortic aneurysm. Patients were stratified into nonagenarian (≥90 years) and non-nonagenarian cohorts. Entropy balancing was used to adjust for baseline differences. Survey-weighted multivariable regression models evaluated the association of nonagenarian status with 30-day mortality, individual complications, nonhome discharge, readmission, and length of stay. Of 14,025 patients, 497 (3.5%) were nonagenarians. Nonagenarians were more likely to be female, had lower body mass index, and carried higher rates of congestive heart failure. Following entropy balancing and multivariable adjustment, nonagenarian status was not independently associated with 30-day mortality (adjusted odds ratio, 1.49; 95% confidence interval, 0.72-3.08; P = .28). Rates of myocardial infarction, acute kidney injury, respiratory complications, and sepsis were comparable between cohorts. Nonagenarian status was associated with increased odds of nonhome discharge (adjusted odds ratio, 3.31; 95% confidence interval, 2.53-4.33; P < .001) and infectious complications (adjusted odds ratio, 1.78; 95% confidence interval, 1.11-2.85; P = .02), along with modestly longer hospital stay (β = 0.62 days; P < .001). Following risk adjustment, nonagenarian status was not associated with increased 30-day mortality or most major complications after elective endovascular aneurysm repair. These findings suggest that appropriately selected nonagenarians can undergo endovascular aneurysm repair with acceptable perioperative risk, supporting individualized assessment over age-based exclusion.