#20 INFRAINGUINAL RECONSTRUCTION IN
OCTOGENARIANS. SHOULD AGE BE A CONTRAINDICATION?
Daniel Choi, MBA, R. Clement Darling, III, MD, Benjamin B. Chang, MD,
William E. Lloyd, MD, Philip S.K. Paty, MD, Paul B. Kreienberg, MD,
and Dhiraj M. Shah, MD
Albany Medical College, Albany, NY.
Purpose: With the graying of America comes an increasing
demand for medical care by the elderly. Unfortunately, due to a
combination of rising costs of health care and driving force from the
public to lower spending, health maintenance organizations and
insurance companies are less willing to pay for expensive surgical
procedures. Recently infrainguinal arterial reconstructions have
been denied solely based on patient's age without adequate evaluation
of data. In this report, we evaluate results of patients greater
than 80 years old who undergo infrainguinal reconstruction and
compared them to younger cohorts during the same time period.
Methods: From 1993 to 1997, 620 octogenarians had
infrainguinal reconstructions performed at our institution. In the
same time period, 3589 procedures were performed on patients less
than 80 years old. Indications for operations were similar in both
groups, with slightly more claudicators (9% to 1%) in the under 80
cohort. Demographics and risk factors were similar in both
groups.
Results: Occlusions in follow-up occurred in 105 patients in
the less than 80 group (5.5%), and 20 (6.2%) in the greater than 80
year old group with continued patency of 95% and 94%, respectively.
Thirty-day postoperative mortality was 4% in patients under 80, and
6% in patients over 80. There is no statistical significance.
Length of stay, postoperative ambulation, and cost of hospitalization
were not statistically significant in either group nor in patients
who are ambulatory on presentation. Seven-year secondary patency
rate was 66% in less than 80 group and 72% in over 80 group.
Conclusion: Health care dollars can be well spent on
octogenarians and they should not be denied infrainguinal arterial
reconstruction based on age alone. Those patients who are greater
than 80 years of age should expect comparable outcomes as their
younger cohorts when undergoing these reconstructions. Age should
not be a contraindication for infrainguinal reconstruction.
