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Jill Goodwin
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Older patients have a greater risk of dying within the first year after surgery to repair a damaged artery in the chest and abdomen, according to research presented today at the annual meeting of the Society for Vascular Surgery in Chicago. When appropriate, patients with this type of artery damage, called thoracoabdominal aneurysm or TAA, undergo surgery to repair the problem and prevent the aneurysm from rupturing.

One year after surgery, approximately one-third of all patients who elect to have unruptured TAAs repaired surgically will have died, a number significantly higher than estimates based on institutional reviews.  This study sought to determine whether older patients face a higher risk of death within the first year after elective surgery and the one-year mortality for all patients in the general population.  The researchers found that the risk of death during the first year after surgery is about 27 percent for patients aged 51-60; 31 percent for patients 61-70; 35 percent for patients aged 71-80; and 43 percent for patients between the ages of 81 and 90.

“Previous studies have focused on the risk of death in the first month after surgery,” said Dr. David Rigberg of UCLA Medical Center, Los Angeles, California. “But these statistics may underestimate the risk of surgical repair for TAA, especially in older patients.” The risk of death within the first 30 days after elective surgery is about 22 percent across all age groups, as compared with 33 percent a year after surgery.

The study was based on hospital discharge data obtained from the California Office of Statewide Health Planning and Development. This allows for longitudinal follow up of patients after they are discharged from the hospital.

The aorta, the largest artery in the body, carries blood away from the heart. When the aorta has a weakened segment that coexists in both the chest and the abdominal sections of the aorta, it is called a thoracoabdominal aneurysm. Over time, the pressure of blood flow can cause the weakened area of the aorta to bulge like a balloon. If the weakened section bursts or ruptures, it is often fatal. Only about 20 to 30 percent of patients who get to the hospital with a ruptured TAA survive.

In general, the mortality risk of elective repair for TAA is higher than for patients who undergo repair of abdominal aortic aneurysm, a much more common condition.