Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study

in collaboration with the Dutch Society of Vascular Surgery; the Steering Committee of the Dutch Surgical Aneurysm Audit; the Dutch Institute for Clinical Auditing

doi:https://doi.org/10.1016/j.ejvs.2021.02.047

Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study

in collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, the Dutch Institute for Clinical Auditing

Research output: Contribution to journal › Article › Academic › peer-review

14 Citations (Scopus)

Abstract

Objective: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. Methods: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. Results: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. Conclusion: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.

Original language	English
Pages (from-to)	920-928
Number of pages	9
Journal	European Journal of Vascular and Endovascular Surgery
Volume	61
Issue number	6
DOIs	https://doi.org/10.1016/j.ejvs.2021.02.047
Publication status	Published - 1 Jun 2021

Keywords

Abdominal aortic aneurysm
Elderly
Endovascular procedure
Octogenarians
Operative surgical procedure

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https://doi.org/10.1016/j.ejvs.2021.02.047

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in collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, & the Dutch Institute for Clinical Auditing (2021). Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study. European Journal of Vascular and Endovascular Surgery, 61(6), 920-928. https://doi.org/10.1016/j.ejvs.2021.02.047

in collaboration with the Dutch Society of Vascular Surgery ; the Steering Committee of the Dutch Surgical Aneurysm Audit ; the Dutch Institute for Clinical Auditing. / Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study : A Nationwide Cohort Study. In: European Journal of Vascular and Endovascular Surgery. 2021 ; Vol. 61, No. 6. pp. 920-928.

@article{1ab916a9fede40f1b1e0d8b66492f342,

title = "Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study",

abstract = "Objective: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. Methods: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. Results: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. Conclusion: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.",

keywords = "Abdominal aortic aneurysm, Elderly, Endovascular procedure, Octogenarians, Operative surgical procedure",

author = "Alberga, {Anna J.} and {in collaboration with the Dutch Society of Vascular Surgery} and Karthaus, {Eleonora G.} and {the Steering Committee of the Dutch Surgical Aneurysm Audit} and {van Zwet}, {Erik W.} and {de Bruin}, {Jorg L.} and {van Herwaarden}, {Joost A.} and Wever, {Jan J.} and Verhagen, {Hence J. M.} and {the Dutch Institute for Clinical Auditing} and {van den Akker}, {P. J.} and Akkersdijk, {G. J.} and Akkersdijk, {G. P.} and Akkersdijk, {W. L.} and {van Andringa de Kempenaer}, {M. G.} and Arts, {C. H.} and Avontuur, {J. A.} and Bakker, {O. J.} and R. Balm and Barendregt, {W. B.} and Bekken, {J. A.} and Bender, {M. H.} and Bendermacher, {B. L.} and {van den Berg}, M. and P. Berger and Beuk, {R. J.} and Blankensteijn, {J. D.} and Bleker, {R. J.} and Blok, {J. J.} and Bode, {A. S.} and Bodegom, {M. E.} and {van der Bogt}, {K. E.} and Boll, {A. P.} and Booster, {M. H.} and {Borger van der Burg}, {B. L.} and {de Borst}, {G. J.} and {Bos- van Rossum}, {W. T.} and J. Bosma and Botman, {J. M.} and Bouwman, {L. H.} and V. Brehm and {de Bruijn}, {M. T.} and {de Bruin}, {J. L.} and P. Brummel and {van Brussel}, {J. P.} and Buijk, {S. E.} and J. Diks and Idu, {M. M.} and {van der Laan}, {M. J.} and Legemate, {D. A.} and Cagdas {\"U}nl{\"u} and {de Vries}, M. and Hoksbergen, {A. W.} and Huisman, {L. C.} and V. Jongkind and R. Konings and Lensvelt, {M. M.} and Mattens, {E. C.} and Nederhoed, {J. H.} and Nieuwenhuis, {D. H.} and Scholtes, {V. P.} and Stigter, {D. A.} and M. Truijers and S. Velthuis and Vermeulen, {C. F.} and Visser, {M. J.} and {Vlijmen - van Keulen}, {C. J.} and Wiersema, {A. M.} and Yeung, {K. K.} and {van Zeeland}, {M. L.}",

note = "Funding Information: The authors would like to thank the members of the Dutch Society for Vascular Surgery who registered their patients in the DSAA, the Dutch Institute for Clinical Auditing that facilitated the registry, and the Steering Committee of the Dutch Surgical Aneurysm Audit. Publisher Copyright: {\textcopyright} 2021 The Author(s)",

year = "2021",

month = jun,

day = "1",

doi = "https://doi.org/10.1016/j.ejvs.2021.02.047",

language = "English",

volume = "61",

pages = "920--928",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "W.B. Saunders Ltd",

number = "6",

}

in collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit & the Dutch Institute for Clinical Auditing 2021, 'Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study', European Journal of Vascular and Endovascular Surgery, vol. 61, no. 6, pp. 920-928. https://doi.org/10.1016/j.ejvs.2021.02.047

Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study. / in collaboration with the Dutch Society of Vascular Surgery; the Steering Committee of the Dutch Surgical Aneurysm Audit; the Dutch Institute for Clinical Auditing.
In: European Journal of Vascular and Endovascular Surgery, Vol. 61, No. 6, 01.06.2021, p. 920-928.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study

T2 - A Nationwide Cohort Study

AU - Alberga, Anna J.

AU - in collaboration with the Dutch Society of Vascular Surgery

AU - Karthaus, Eleonora G.

AU - the Steering Committee of the Dutch Surgical Aneurysm Audit

AU - van Zwet, Erik W.

AU - de Bruin, Jorg L.

AU - van Herwaarden, Joost A.

AU - Wever, Jan J.

AU - Verhagen, Hence J. M.

AU - the Dutch Institute for Clinical Auditing

AU - van den Akker, P. J.

AU - Akkersdijk, G. J.

AU - Akkersdijk, G. P.

AU - Akkersdijk, W. L.

AU - van Andringa de Kempenaer, M. G.

AU - Arts, C. H.

AU - Avontuur, J. A.

AU - Bakker, O. J.

AU - Balm, R.

AU - Barendregt, W. B.

AU - Bekken, J. A.

AU - Bender, M. H.

AU - Bendermacher, B. L.

AU - van den Berg, M.

AU - Berger, P.

AU - Beuk, R. J.

AU - Blankensteijn, J. D.

AU - Bleker, R. J.

AU - Blok, J. J.

AU - Bode, A. S.

AU - Bodegom, M. E.

AU - van der Bogt, K. E.

AU - Boll, A. P.

AU - Booster, M. H.

AU - Borger van der Burg, B. L.

AU - de Borst, G. J.

AU - Bos- van Rossum, W. T.

AU - Bosma, J.

AU - Botman, J. M.

AU - Bouwman, L. H.

AU - Brehm, V.

AU - de Bruijn, M. T.

AU - de Bruin, J. L.

AU - Brummel, P.

AU - van Brussel, J. P.

AU - Buijk, S. E.

AU - Diks, J.

AU - Idu, M. M.

AU - van der Laan, M. J.

AU - Legemate, D. A.

AU - Ünlü, Cagdas

AU - de Vries, M.

AU - Hoksbergen, A. W.

AU - Huisman, L. C.

AU - Jongkind, V.

AU - Konings, R.

AU - Lensvelt, M. M.

AU - Mattens, E. C.

AU - Nederhoed, J. H.

AU - Nieuwenhuis, D. H.

AU - Scholtes, V. P.

AU - Stigter, D. A.

AU - Truijers, M.

AU - Velthuis, S.

AU - Vermeulen, C. F.

AU - Visser, M. J.

AU - Vlijmen - van Keulen, C. J.

AU - Wiersema, A. M.

AU - Yeung, K. K.

AU - van Zeeland, M. L.

N1 - Funding Information: The authors would like to thank the members of the Dutch Society for Vascular Surgery who registered their patients in the DSAA, the Dutch Institute for Clinical Auditing that facilitated the registry, and the Steering Committee of the Dutch Surgical Aneurysm Audit. Publisher Copyright: © 2021 The Author(s)

PY - 2021/6/1

Y1 - 2021/6/1

N2 - Objective: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. Methods: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. Results: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. Conclusion: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.

AB - Objective: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. Methods: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. Results: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. Conclusion: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.

KW - Abdominal aortic aneurysm

KW - Elderly

KW - Endovascular procedure

KW - Octogenarians

KW - Operative surgical procedure

UR - http://www.scopus.com/inward/record.url?scp=85102820291&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/j.ejvs.2021.02.047

DO - https://doi.org/10.1016/j.ejvs.2021.02.047

M3 - Article

C2 - 33875325

SN - 1078-5884

VL - 61

SP - 920

EP - 928

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 6

ER -

in collaboration with the Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, the Dutch Institute for Clinical Auditing. Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study. European Journal of Vascular and Endovascular Surgery. 2021 Jun 1;61(6):920-928. doi: https://doi.org/10.1016/j.ejvs.2021.02.047

Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study: A Nationwide Cohort Study

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Keywords

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