Surgical treatment of ruptured abdominal aortic aneurysms in the elderly

The aims of this study were to investigate current results of surgical trea tment for elderly patients with ruptured abdominal aortic aneurysms (AAA) a nd to define factors associated with mortality. The study included 112 pati ents aged 75 years or older who were operated on for a ruptured AAA. The su rgeries took place from January 1995 to December 1996 in 21 hospitals in Sp ain. Variables that could be related to death were retrospectively analyzed by entering data into SPSS statistical software. These variables included sex, age, diabetes, hypertension, cardiopathy, pulmonary obstructive diseas e, renal dysfunction, symptomatic cerebrovascular disease, peripheral occlu sive disease, peripheral aneurysms, hematocrit on admission, preoperative h ypotension, loss of consciousness, cardiac arrest, AAA location, aneurysm s ize, type of rupture, place of aortic cross-clamping, type of graft, use of cell saver, technical complications, intraoperative blood loss, and transf usion requirements. Postoperative complications were also considered, inclu ding renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation. For univariate statistical analysis, the Student's t-test, Ma nn-Whitney test, and chi-square test were used. Those variables showing sta tistical significance were entered into a multivariate logistic regression model. The results of these analyses indicate that in elderly patients unde rgoing surgery for ruptured AAA have a high operative mortality. Comorbid f actors, however, were not identified as independent predictors of death. Su rgery should not be denied these patients and selective screening should be contemplated.