Open Repair for Nonruptured Abdominal Aortic Aneurysm in Octogenarians With Prior Abdominal Surgery

Abstract

Introduction

Previous abdominal surgery (PAS) has been shown to potentially affect outcomes of open surgical repair (OSR) for abdominal aortic aneurysm (AAA). Octogenarians have been observed to face significantly higher risks following OSR for AAA, which highlights the need for a more cautious selection of their surgical candidacy. This study aimed to assess the association between PAS and the 30-d outcomes of OSR for nonemergent intact AAA among octogenarians.

Methods

Octogenarians (aged ≥80 y) who underwent OSR for AAA were identified in American College of Surgeons National Surgical Quality Improvement Program targeted databases from 2012 to 2022. Exclusion criteria included emergency and ruptured aneurysm. Multivariable logistic regression was used to compare 30-d perioperative outcomes between octogenarians with and without PAS while adjusting for demographics, comorbidities, indications, aneurysm extents, and surgical approaches.

Results

Among 4242 patients who underwent OSR for nonemergent intact AAAs, 562 patients (13.25%) were octogenarians. Among the octogenarians, 173 (30.78%) had PAS, whereas 389 (69.22%) had no history of PAS. Octogenarians with and without PAS had comparable 30-d mortality (10.4% versus 9.51%, adjusted odds ratio 1.104, 95% confidence interval 0.581-2.095, P = 0.76). However, octogenarian patients with PAS had a higher risk of lower extremity ischemia (9.83% versus 4.37%, adjusted odds ratio 2.247, 95% confidence interval 1.064-4.745, P = 0.03). All other 30-d surgical outcomes did not differ between octogenarians with and without PAS. In addition, unplanned reoperation, discharge not to home, 30-d readmission, operation time, and length of stay were not different between the groups.

Conclusions

Octogenarians with a history of PAS had largely similar 30-d mortality and morbidities, except a 2.25 times higher risk of lower extremity ischemia. Therefore, although a history of PAS should not preclude octogenarian patients from undergoing OSR for AAA, additional vigilance for postoperative lower extremity ischemia is warranted to ensure timely and appropriate secondary interventions.