Carotid Surgery in Octogenarians in Veterans Affairs Medical Centers

Kazmers, Andris; Perkins, Anthony J.; Huber, Thomas S.; Jacobs, Lloyd A.

doi:10.1006/jsre.1998.5459

Cited by 32 publications

(15 citation statements)

References 30 publications

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“…The rate among those older than 75 years of age was lower than reported for symptomatic patients in NASCET and ECST, which indicates either that surgical therapy has become safer with time or that the inherent risks of these cohorts differed in important ways. Several reports point to higher risks of complications among older patients undergoing CEA, 426,427 but others suggest that patients 75 years of age or older with few cardiovascular risk factors face risks of perioperative stroke and death comparable to younger patients. 428 Women undergoing CEA face higher operative risk than men (10.4% versus 5.8% for men in ECST).…”

Section: Demographic and Clinical Factorsmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

140

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Section: Demographic and Clinical Factorsmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

140

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“…Mortality, resource utilization, and LOS were greater (by a mean of 3.2 days) for octogenarians in the VAMC population undergoing CEA. 12 The review of Collins et al 11 also identified the variables associated with prolonged LOS at VAMCs as functional status, American Society of Anesthesiology class, and age. 11 Perler et al 13 reviewed the Maryland State database for patients undergoing CEA and found that mean LOS and hospital charges increased linearly with increasing age.…”

Section: Discussionmentioning

confidence: 98%

Factors predicting prolonged length of stay after carotid endarterectomy

Roddy

Estes

Kwoun

et al. 2000

Journal of Vascular Surgery

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“…Of these, 7 papers reported risks in older patients but did not compare their results to younger patients in the same centre(s) and were therefore excluded. Among the 62 remaining eligible papers [35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97], there were no differences in the associations between either age or sex and overall 30-day stroke rate, death rate or combined stroke and death rate between studies reporting the associations as their primary aim and those which reported them as a subanalysis along with other risk factors (fig. 1, 2) and so data from both types of study are combined in the analyses below.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Associations between Age and Sex and the Operative Risks of Carotid Endarterectomy

et al. 2005

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Background: Randomized trials of carotid endarterectomy (CEA) for both symptomatic and asymptomatic carotid stenosis have demonstrated that benefit is decreased in women, due partly to a high operative risk, which is independent of age. However, it is uncertain whether these trial-based observations are generalisable to routine clinical practice. Methods: We performed a systematic review of all publications reporting data on the association between age and/or sex and procedural risk of stroke and/or death following CEA from 1980 to 2004. Results: 62 eligible papers reported relevant data. Females had a higher rate of operative stroke and death (25 studies, OR = 1.31, 95% CI = 1.17–1.47, p < 0.001) than males, but no increase in operative mortality (15 studies, OR = 1.05, 95% CI = 0.81–0.86, p = 0.78). Compared with younger patients, operative mortality was increased at ≧75 years (20 studies, OR = 1.36, 95% CI = 1.07–1.68, p = 0.02), at age ≧80 years (15 studies, OR = 1.80, 95% CI = 1.26–2.45, p < 0.001) and in older patients overall (35 studies, OR = 1.50, 95% CI = 1.26–1.78, p < 0.001). In contrast, risk of non-fatal stroke did not increase with age and so the combined perioperative risk was only slightly increased at age ≧75 years (21 studies, OR = 1.18, 95% CI = 0.94–1.44, p = 0.06), at age ≧80 years (10 studies, OR = 1.14, 95% CI = 0.92–1.36, p = 0.34) and in older patients overall (36 studies, OR = 1.17, 95% CI = 1.04–1.31, p = 0.01). Conclusions: The effects of age and sex on the operative risk of CEA in published case series are consistent with those observed in the trials. Operative risk of stroke is increased in women and operative mortality is increased in patients aged ≧75 years.

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Carotid Surgery in Octogenarians in Veterans Affairs Medical Centers

Cited by 32 publications

References 30 publications

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Factors predicting prolonged length of stay after carotid endarterectomy

A Systematic Review of the Associations between Age and Sex and the Operative Risks of Carotid Endarterectomy

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