Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysm in Patients >80 Years Old: A Systematic Review and Meta-analysis

Background The role of open repair in the management of ruptured abdominal aortic aneurysm (RAAA) in patients >80 years old is questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies. Methods Studies on open repair of RAAA in patients >80 years old were identified in July 2010. The immediate and intermediate results were expressed as pooled proportions with 95% confidence interval (95% CI). Linear regression and meta-regression were performed to evaluate the impact of variables on the immediate postoperative mortality. Results Pooled analysis of 29 studies showed that the risk of immediate postoperative mortality in patients >80 years old was significantly higher than in younger patients (risk ratio 1.440, 95% CI 1.365-1.519, I-2 36.8%, P = 0.002; risk difference 19.4%, 95% CI 16.4-22.4%, I-2 38.8%, P = 0.019). Pooled analysis of 36 studies showed an immediate postoperative mortality rate of 59.2% (95% CI 55.7-62.5, I-2 35.62). Immediate postoperative mortality in patients <80 years old positively correlated with that of patients >80 years old (rho: 0.686, P < 0.0001). Intermediate survival data of 111 operative survivors were available from six studies, and their pooled survival rates at 1-, 2-, and 3-year were 82.4, 75.6, and 68.7%, respectively. Conclusions Immediate and intermediate survival rates of patients >80 years old after open repair of RAAA are acceptable. These findings suggest a more confident approach toward emergency repair of RAAA in the very elderly.