Postendarterectomy Mortality in Octogenarians and Nonagenarians in the USA from 1993 to 1999

Abstract

Background: Relatively little is known about trends in the utilization or outcomes of carotid endarterectomy (CEA) in the very elderly. We determined trends in the rates of CEA and perioperative (in-hospital and 30-day) and long-term (1-, 2-, 3-, 4- and 5-year) mortality in a US national sample of patients ≧80 years of age. Methods: All fee-for-service Medicare patients (80–89 and ≧90 years of age) who had a CEA [ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification): 38.12] from 1993 to 1999 were identified using the Centers for Medicare and Medicaid Services Inpatient Standard Analytic Files. Demographic characteristics and comorbid conditions were determined using ICD-9-CM diagnostic codes within the year prior to the index hospitalization for CEA. Results: A total of 140,376 CEA were performed in patients aged 80–89 years and 6,446 in those aged ≧90 years during this 7-year period. The annual number of operations increased from 13,115 in 1993 to 21,582 in 1999 for octogenarians, and from 481 in 1993 to 1,257 in 1999 for nonagenarians. Perioperative mortality was 2.2% in octogenarians and 3.3% in nonagenarians. Long-term mortality increased by approximately 10% per year after the operation, and was 43% in octogenarians and 56% in nonagenarians at 5 years. Perioperative mortality rates remained relatively stable over the 7-year period for both age groups although comorbidities increased. Conclusions: The number of CEA performed in the very elderly in the USA increased from 1993 to 1999. Perioperative mortality rates were high compared with trial results, while long-term survivorship was comparable to that of similarly-aged peers in the USA.

Is Age of 80 Years a Threshold for Carotid Revascularization?

“…The by far largest cohort was reported by Lichtman et al . who analyzed data of all 140.376 patients older than 80 years undergoing CEA in the United States during a period of 6 years (1993-1999) [ 33 ]. They collected data on patients from their medical records.…”

A comparison of results of carotid endarterectomy in octogenarians and nonagenarians to younger patients from the Mid-America Vascular Study Group and the Society for Vascular Surgery Vascular Quality Initiative

“…16 Analyses from administrative databases, probably not subject to publication bias as single-center studies may be, have often concluded that older patients suffer more complications than do younger patients and patients in prospective studies. 25,26 However, some of the data contributing to these latter studies are now >20 years old and are not likely to reflect current results after CEA. Furthermore, as noted before, many of the precedent studies are single-institution studies.…”

Do Octogenarians Still Have a High Risk of Adverse Outcomes after Carotid Endarterectomy in the Era of a Super-aged Society? A Single-center Study in Japan

“…Several larger studies have reported on outcomes after CEA in octogenarians in Western countries. 12,13 Rajamani et al 13 studied 4149 patients 70 years of age or older and found that patients aged 80-84 years had relatively good outcomes. However, that study did not show the outcome analysis.…”

“…However, that study did not show the outcome analysis. Lichtman et al 12 reported the perioperative and follow-up mortality rates of 140,376 patients 80 years of age or older who underwent CEA in the United States. They reported a perioperative mortality rate of 2.2% but did not indicate the causes of death or rate of death due to ischemic stroke.…”