Thoracoabdominal aortic replacement in the elderly: a retrospective propensity score-matched outcome analysis

Background and objectives: With the overall aging population, the demand for thoracoabdominal aortic repair in elderly patients will continue to increase. With rising frequency, surgeons and physicians will have to decide whether this highly invasive procedure is appropriate and rational for their elderly patients. However, data focused on the outcomes of thoracoabdominal repair in elderly patients is still lacking to date. Methods: We here report a propensity score-matched, single-center analysis of 309 consecutive patients who underwent open surgical thoracoabdominal aortic repair from 2000 to 2024. Of those, 72 patients (23.3%) were 70 years of age or older. Matching for preoperative characteristics, burden of disease, and extent of repair revealed 68 one-on-one matches of patients below or above 70 years of age. These were then analyzed for intraoperative characteristics as well as postoperative events, complications, and mortality. Results: Elderly patients had longer intensive care unit stay times, with 6 days [interquartile range (IQR) 3–14] versus 3 days (IQR 2–8, P = 0.007), as well as higher rates of postoperative complications. Among these complications, respiratory failure (47.1% vs. 25.0%, P = 0.007), acute kidney failure (30.9% vs. 14.7%, P = 0.025), and new-onset atrial fibrillation (14.7% vs. 4.4%, P = 0.041) were found significantly more often in patients aged 70 years or older. In contrast, 30-day mortality did not differ significantly between the two groups (17.6% vs. 13.2%, P = 0.636). Conclusion: Elderly patients were more frequently prone to a prolonged and complicated postoperative course. However, this did not result in excessive short-term mortality. Thus, elderly patients should be critically evaluated before undergoing thoracoabdominal aortic repair, and both patients and surgeons should be prepared for prolonged ICU times. However, age alone should not be an exclusion criterion for thoracoabdominal aortic repair, which can be performed with acceptable short-term mortality rates.