Abdominal aortic aneurysm surgery in octogenarians

Background: It is difficult to decide whether to operate on a symptomless, abdominal aortic aneurysm in an elderly person almost in the last decade of their life. Patients and Methods: A comparative retrospective review was undertaken of 77 octogenarians and 692 other patients aged less than 80 treated for infrarenal abdominal aortic aneurysms between January 1980 and July 1992 at the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital, Finland. Of these 77 octogenarians, 60 underwent surgery and 17 were treated non-surgically. Of the 60, 48 (80%), and 284 of the 692 (41%) non-octogenarians underwent emergency surgery either because of ruptured aneurysm (RAAA group: 35 octogenarians and 213 non-octogenarians) or because of non-ruptured but impending rupture (NRAAA group: 13 octogenarians and 71 non-octogenarians). Results: Emergency surgery was more frequent among octogenarians than among younger patients (p < 0.001) and was associated with significantly higher 30-day mortality rates in the RAAA group: 71% (22/35) versus 36% (76/213) (p < 0.01) and in the NRAAA group: 38% (5/13) versus 14% (10/71) (p < 0.05). Elective surgery for symptomless abdominal aortic aneurysms (AAA group) was associated with 8% (1/12) 30-day mortality rates in octogenarians and 8% (33/408) in non-octogenarians. Survival rates for non-surgically treated symptomless octogenarians were statistically significantly lower (lag rank test) than for electively treated octogenarians and for an age-and sex-matched Finnish population. Median survival for non-surgically treated octogenarians was 2.5 years (SE 0.13), with 50% of the patients dying from rupture of their aneurysms during the follow-up period. Conclusion: These findings support the active treatment of abdominal aortic aneurysms on an elective basis among the elderly.