Open AccessRenal disease, age and outcome after aortic aneursym repair
Author(s) -
Refson J.,
Wilmink T.,
Kerle M.,
Pillay W.,
Mansfield A.,
Cheshire N. J. W.,
Wolfe J. H. N.
Publication year - 2001
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2001.01757-36.x
Subject(s) - medicine , creatinine , diabetes mellitus , renal function , perioperative , risk factor , aneurysm , surgery , logistic regression , relative risk , disease , cardiology , confidence interval , endocrinology
Background: The safety of conventional aneurysm repair is undergoing increased scrutiny as less invasive methods are developed, certain high‐risk groups identified and the evidence for the risk of rupture is refined. An understanding of the relationship between preoperative risk factors and outcome is particularly important in elderly patients requiring a prophylactic operation. Methods: Risk factors (extent of aneurysm, ischaemic heart disease, renal function, hypertension, diabetes, serum cholesterol concentration, age and sex) were studied in 393 consecutive patients undergoing elective juxtarenal and infrarenal aneurysm repair between 1993 and 1999 (inclusive), and were related to hospital mortality. Results: The overall mortality rate was 5·1 per cent (20 of 393). Multivariate logistic regression analysis revealed that age and creatinine concentration were independent risk factors for in‐hospital mortality. Extent of aneurysm was not an independent risk factor, nor was a history of myocardial ischaemia, sex, hypertension, diabetes or serum cholesterol level. The comparative risk related to age and serum creatinine concentration is shown in the Table .Age (years) Creatinine (µmol l −1 ) Mortality rate (%)< 70 > 60 0·5 (0·0–1·1) > 70 < 120 4·7 (2·5–6·9) > 70 121–180 14·1 (4·5–23·7) > 70 > 180 16·7 (0·0–34·7)Values in parentheses are 95 per cent confidence intervals (c.i.)Creatinine level had no influence on outcome in patients aged under 70 years. However, in those over 70 years of age, an increase in creatinine concentration of 10 μmol l −1 increased the relative risk by 0·1 (95 per cent c.i. 0·01–0·18). Increasing age by 10 years increased the relative risk by 1·5 (95 per cent c.i. 0·6–2·4). Conclusion: Advances in preoperative and perioperative care appear to have reduced the significance of ischaemic heart disease and juxtarenal repair so that age and renal disease are currently major determinants of survival. In aneurysms of less than 7 cm in diameter, where the risk of rupture is less than 10 per cent per year, the natural history of the disease in elderly patients with renal failure appears to be more benign than the treatment. © 2001 British Journal of Surgery Society Ltd