Carotid surgery in octogenarians in Veterans Affairs medical centers

The purpose of this study was to define outcomes after carotid surgery in o ctogenarians in the Veterans Affairs health care system. During fiscal year s 1991-1994, 9152 patients in DRG 5 underwent extracranial vascular surgery procedures in Veterans Affairs medical centers. Those greater than or equa l to 80 years of age constituted 2.1% (n = 195) of such patients. In-hospit al mortality rates were 1.03% (92/8957) in those <80 versus 3.08% (6/195) i n those greater than or equal to 80 years old (P = 0.018). Of those greater than or equal to 80, 11.8% (23/195) had an ICD-9-CM-coded complication dur ing hospitalization versus 11.2% of those <80 (1004/8957, NS). Surgical com plications of the central nervous system (CNS) were present in 0.51% of oct ogenarians (1/195) and in 0.93% of those younger (83/8957, NS). Myocardial infarction (MI) occurred in 1.0% (2/195) of octogenarians and 0.74% (66/896 7) of younger patients (NS). Patient Management Category software was used to define illness severity and resource intensity scale (RIS, a measure of resource utilization). Logistic regression analysis showed that age, illnes s severity, MI, and surgical complications of the CNS were associated with greater likelihood of mortality after extracranial vascular surgery. When t he dichotomous variable "octogenarian status" was substituted for the conti nuous variable "age,n in this model, there was no significant association o f octogenarian status per se with mortality, though the association of illn ess severity, MI, and CNS complications with mortality persisted. Illness s everity was greater for octogenarians (2.03 +/- 1.36) versus those younger (1.84 +/- 1.13, P < 0.05). RIS was 2.57 +/- 0.57 in octogenarians versus 2. 47 +/- 0.48 for younger patients (P < 0.015). Length of stay (LOS) was a me an of 3.2 days longer for octogenarians (P < 0.001). The risk of postoperat ive CNS complications was not higher in octogenarians. Mortality, resource utilization, and length of stay were, however, greater for octogenarians, b ut so was illness severity. Though mortality rates were greater for octogen arians in DRG 5, illness severity, MI, and postoperative CNS complications had greater impact on mortality after extracranial vascular surgery than oc togenarian status per se. (C) 1999 Academic Press.