Long-term relative survival in elderly patients after carotid endarterectomy - A population-based study

Background and Purpose-Octogenarians were not included in the major trials of carotid endarterectomy. Concern has been expressed about the role of carotid endarterectomy in this age group. This concern is based in part on uncertainty about the long-term survival of elderly patients after carotid endarterectomy. The aim of the present study was to assess relative survival in those patients greater than or equal to80 years of age undergoing carotid endarterectomy. Methods-A population-based record linkage study of all patients who underwent carotid endarterectomy from 1988 to 1998 in Western Australia was undertaken. Long-term relative survival after carotid endarterectomy was assessed against age- and sex-matched controls. Results-During the period 1988 to 1998, 1796 (1306 male, 490 female) cases were identified. There were 151 patients greater than or equal to80 years of age. The cumulative survival at 5 years was 64.9% for those greater than or equal to80 years of age compared with 80.1% for those greater than or equal to80 years of age. Relative survival at 5 years was 118% (95% CI, 102 to 134) for those greater than or equal to80 years of age compared with 94.7% (95% CI, 92 to 97) for those greater than or equal to80 years of age. Conclusions-Long-term relative survival after carotid endarterectomy in patients greater than or equal to80 years of age was better than that of an age-matched population. The likelihood of living long enough to gain benefit from a carotid endarterectomy is not jeopardized by being too old.