Abstract 3518: Elderly Patients Undergoing Major Non-Cardiac Surgery: Perioperative and Long-Term Risk Reduction
Background: Elderly patients undergoing major vascular surgery often experience postoperative complications, which may be due to age itself or to concomitant risk factors such as preexisting ischemic heart disease. We assessed whether age is independently associated with hospital and long-term mortality and whether cardiac medication can reduce the risk of mortality in elderly patients undergoing major vascular surgery.
Methods: In this observational cohort study, 1693 patients aged >65 years undergoing major non-cardiac vascular surgery were preoperatively screened for cardiac risk factors according to the Cardiac Risk Index. Chronic perioperative cardiac medication was also recorded. During a median follow-up of 8.2 years (IQ range: 5.1–10.9), mortality was noted.
Results: Mean age was 73 ±5 years and 76% was male. Hospital and long-term mortality occurred in 137 (8.1%) and 482 (29%) patients respectively. In multivariate analysis, age was independently associated with increased hospital and long-term mortality (per year increase: OR 1.04, 95% CI: 1.01–1.08, p<0.001, HR: 1.04, 95% CI: 1.01–1.05, p<0.001, respectively). Perioperative use of aspirin, β-blockers and statins was significantly associated with a 47%, 68%, and 65% reduced risk of hospital mortality, respectively. In addition, aspirin, angiotensin-converting enzyme (ACE) inhibitors,β-blockers and statins were associated with a 35%, 26%, 39%, and 35% reduced risk of long-term mortality, respectively (Table⇓). Tests for heterogeneity revealed a gradient decrease of mortality risk in patients from low to high age who were using statins (p=0.03).
Conclusion: Increasing age is a significant and independent predictor of hospital and long-term mortality in elderly patients undergoing major vascular surgery. In these patients, aspirin, ACE inhibitors, β-blockers and statins may reduce hospital and long-term mortality risk. Especially the very elderly may benefit from statin therapy.