Age-stratified outcomes in elderly patients undergoing open and endovascular procedures for aortoiliac occlusive disease

Background: The elderly comprise a sizeable segment of patients with aortoiliac occlusive disease (AIOD). We analyzed outcomes in elderly patients who underwent open and endovascular procedures for AIOD. Methods: Elderly patients with AIOD who underwent open and endovascular procedures in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database from 2004 to 2007 were identified. Patients were stratified into age groups: 65-69 years, 70-79 years, and 80 years or older. The clinical outcomes were complications and mortality; the economic outcomes were duration of stay and hospital cost. Both open and endovascular procedures were compared using χ² analysis, analysis of variance (ANOVA), and multivariate linear and logistic regression. Results: Patients aged 80 years or older were more likely be nonelective admissions (43%), have a high Charlson Comorbidity Index (12%), and have iliac artery disease (63%, all P < .05). Patients aged 80 years or older who underwent open procedures had higher complication and mortality rates compared with younger patients (both P < .05). Endovascular procedures had a lower complication rate, duration of stay, and hospital cost for all age groups (P < .05). Mortality was significantly lower for endovascular treatment in patients aged 70 years or older (P < .05). A multivariate analysis showed patients aged 70 years or older were at increased risk of complications (P < .05). Conclusion: For both procedures, clinical outcomes worsen as patient age increases. In patients aged 70 years or older, endovascular treatment conferred a lower complication rate than open repair.