Fenestrated endovascular abdominal aortic aneurysm repair in octogenarians is associated with higher mortality and an increased incidence of nonhome discharge

Objective: Fenestrated endovascular abdominal aortic aneurysm repair (FEVAR) has been increasingly becoming the endovascular treatment of choice for patients with juxtarenal abdominal aortic aneurysms with an infrarenal neck, not suitable for traditional endovascular abdominal aortic aneurysm repair. Older patients are at a high risk of developing complications after elective procedures. A review of the literature showed mixed results for FEVAR in the elderly patient population. In the present study, we investigated the occurrence of mortality (both short and long term), discharge destination, and other postoperative outcomes in the octogenarian population who had undergone FEVAR for the management of abdominal aortic aneurysms in a large, national surgical database. Methods: A retrospective analysis of patients who had undergone FEVAR in the Society for Vascular Surgery Vascular Quality Initiative database was performed from July 2010 to June 2019. The study cohort excluded patients aged <18 years and concomitant procedures for snorkeling of visceral branches of the aorta. The final selected cohort was divided into two patient groups: group I, patients aged <80 years (nonoctogenarians); and group II, patients aged ≥80 years (octogenarians). The primary outcomes were mortality at 30 days (short term), 6 months, and 1 year (long term) and the discharge destination. The secondary outcomes included postoperative length of stay, intensive care unit stay, postoperative major cardiac events, and the need for intervention. Computation of models to measure the outcomes and identify the risk factors contributing to mortality at 30 days and discharge to a nonhome destination was performed using multiple logistic regression analyses. Cox proportional hazards regression analysis was performed to study the long-term mortality in the patient groups. Results: A total of 5507 patients had undergone FEVAR in the 9-year period in the Society for Vascular Surgery Vascular Quality Initiative database (group I, nonoctogenarians, n = 4424 [80.3%]; group II, octogenarians, n = 1156 [19.7%]). Octogenarians were more likely to be women, white, Medicare insured, and hypertensive. This group also had lower rates of former or current smokers, a lower glomerular filtration rate, a lower incidence of late-stage chronic kidney disease, and an aneurysm diameter >5.5 cm. Greater estimated blood loss and longer procedures were also noted in the octogenarian group compared with the nonoctogenarian group. Multiple logistic regression analysis showed that octogenarians had had greater mortality at 30 days (7.3%; adjusted odds ratio [aOR], 1.21; 95% confidence interval [CI], 1.0-1.45; P = .044), 6 months (13.7%; aOR, 1.52; 95% CI, 1.24-1.81; P < .001), and 1 year (17.5%; aOR, 1.67; 95% CI, 1.34-2.07; P < .001). The present analysis to measure the discharge destination showed that octogenarians had a greater risk of discharge to nonhome destinations (26.7%; aOR, 1.50; 95% CI, 1.24-1.81; P < .001). Octogenarians had a lower risk of ≥2 days of an intensive care unit stay (aOR, 0.76; 95% CI, 0.67-0.91; P < .001) but a greater risk of experiencing dysrhythmia (10.1%; aOR, 1.32; 95% CI, 1.01-7.1; P = .036) following the procedure compared with the nonoctogenarians. Conclusions: In our retrospective analysis of a large, national surgical database, we found that of the patients undergoing FEVAR to manage juxtarenal abdominal aortic aneurysms, octogenarians had greater mortality and a greater risk of being discharged to nonhome locations compared with nonoctogenarians.