The under-representation of the oldest old in vascular surgery trials, their projected growth, and limited life expectancy challenge clinical and policy-level decisions. This study examines the impact of age ≥ 80 years on short-term outcomes after carotid endarterectomy (CEA), open (OAAA) and endovascular abdominal aortic aneurysm repair (EVAR) and lower extremity bypass (LEB).

Using 2005-2009 ACS-NSQIP, patients ≥ 50 years receiving CEA, OAAA, EVAR and LEB were identified. Chi Square and logistic regression were used to study bivariate and risk-adjusted effects of age on 30-day mortality, major adverse events and prolonged post-operative stay.

Of 56,506 patients, 21% were ≥ 80 years. Of those, 42%, underwent CEA, 21% EVAR, 4.3% OAAA and 33% LEB. Overall, 30-day mortality was 1.9%, major adverse events 16% and 33% had prolonged stay. Stratified multivariate analysis showed older age predicted higher rates of 30-day mortality, likelihood of adverse events, and prolonged stay (Table).
TableOlder Age and Outcomes After Major Vascular Surgery‡Age Groups30-day MortalityMajor ComplicationsProlonged Stay†OR (95%CI)OR (95% CI)OR (95% CI)65-79 yrsRefRefRefCarotid Endarterectomy80-84 yrs2.0*(1.3-3.0)1.1(0.9-1.2)1.3*(1.2-1.5)> 85 yrs2.4*(1.4-3.9)1.2(0.9-1.4)1.6*(1.5-1.8)Endovascular Abdominal Aortic Aneurysm Repair80-84 yrs1.7*(1.1-2.7)1.3*(1.0-1.6)1.3*(1.1-1.4)> 85 yrs1.9*(1.1-3.4)1.3*(1.0-1.7)1.8*(1.6-2.2)Open Abdominal Aortic Aneurysm Repair80-84 yrs1.3(0.7-2.3)0.9(0.8-1.3)1.3*(1.0-1.8)> 85 yrs2.1*(1.0-4.1)1.2(0.8-1.8)1.2(0.8-1.8)Lower Extremity Bypass80-84 yrs1.4*(1.1-1.8)1.1(0.9-1.2)1.2*(1.1-1.4)> 85 yrs1.6*(1.2-2.1)0.9(0.8-1.0)1.1*(1.0-1.3)Table abbreviations: OR=Odds Ratio; CI=Confidence Interval; Ref=Referent.‡adjusted for demographics, pre, and intra-operative factors; age-group 50-64 not shown.†prolonged stay defined as > 75th percentile of post-operative stay for each surgery.

In contrast to current literature, these results suggest that older age predicts worse short-term outcomes after major vascular surgery. In the absence of clinical trials data for this growing population, these results present a platform to health professionals, regulators, and payers to the design of future clinical trials and health policies.