Older age predicts 30-day mortality after EVAR

Age is independently associated with 30-day mortality after endovascular aortic repair (EVAR), a study has found. However, no differences are seen after propensity-score matching (PSM), suggesting that being ≥90 years of age but with similar comorbidities to younger patients is not associated with short-term mortality following EVAR.

“Age ≥90 years alone should not exclude patients from EVAR, and tailored indications and carefully balanced risk assessment are advised,” the authors said.

A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database including EVAR procedures was conducted from 2011 to 2017. The authors performed multivariate logistic regression in the unadjusted cohort, followed by PSM. Thirty-day mortality and 30-day major adverse events were the primary outcomes.

Of the 12,267 patients included, 365 were nonagenarians (NAs). Ruptured aneurysms occurred in 6.7 percent of patients: 15.7 percent (n=57) in NAs and 6.5 percent (n=762) in non-nonagenarians (NNAs) (p<0.001). Mean aneurysm diameter was 6.5±1.8 cm in NAs vs 5.8±1.7 cm in NNAs (p<0.001).

The unadjusted 30-day mortality was higher among NAs than NNAs (9.9 percent vs 2.2 percent; p<0.001). In multivariate analysis, age ≥90 years (odds ratio [OR], 3.36), male sex (OR, 1.78), functional status (OR, 4.22), preoperative ventilator dependency (OR, 3.80), bleeding disorders (OR, 1.52), dialysis (OR, 2.56), and ruptured aneurysms (OR, 17.21) independently predicted mortality.

After PSM, there were no differences found in 30-day mortality (intact abdominal aortic aneurysm [AAA]: 5.3 percent NA vs 3 percent NNA; p=0.15; ruptured AAA: 38 percent NA vs 28.6 percent NNA; p=0.32) or 30-day major adverse events (intact AAA: 7 percent NA vs 4.6 percent NNA; p=0.22; ruptured AAA: 28 percent NA vs 36.7 percent NNA; p=0.35).