老年急性心肌梗死患者溶栓疗效及安全性

目的　探讨老年急性心肌梗死 (AMI)患者接受静脉溶栓治疗的疗效及安全性。方法　回顾分析 3年内收治的AMI 643例中 30 2例接受静脉溶栓治疗的临床疗效。结果　 1 94例老年 (≥ 60岁 )组与 1 0 8例非老年组之间比较 ,其梗死相关血管 (IRA)再通率 (67.0 % ,73 .1 % )和出血及并发症率 (7.7% ,5 .65 % )均差异无显著性意义 (P >0 .0 5) ;所有接受溶栓治疗的AMI患者比不溶栓者的病死率 (7 0 % ,1 4 .7% )、中度以上心力衰竭发生率 (1 7.5 % ,30 .5 % )等明显减低 (P <0 .0 1 ) ;高龄 (≥ 80岁 )AMI2 9例中 ,8例溶栓者比不溶栓者的病死率低 1 6 .1 % ,中度以上心力衰竭低 32 .1 %。结论　AMI溶栓治疗在不同年龄组均安全、有效 ,而高龄患者得益更大     

直接经皮冠状动脉介入治疗高龄老年人急性心肌梗死的临床分析

目的探讨直接经皮冠状动脉介入(PCI)治疗80岁以上高龄老年人急性心肌梗死(AMI)的临床疗效和安全性。方法86例80岁以上高龄老年AMI患者,入院后直接PCI。观察手术成功率、并发症、住院死亡率和心脏事件,出院前左心室射血分数(LVEF)。结果冠状动脉造影示梗死相关血管(IRA)血流TIMI0～1级,除2例心源性休克患者术中因室颤死亡,其余病例均成功开通IRA,手术成功率97.7%,术后68例血流TIMI3级,16例TIMI2级。26例心功能Killip3级以上者使用主动脉内球囊反搏(IABP)辅助循环,术后6例因左心功能衰竭死亡。多支病变者除20例3支病变外,均在术后3～7d行非IRA的PCI。仅3.6%发生需输血的出血并发症。住院总死亡率为9.3%,KIillip3级以上者死亡率为30.8%。住院期间无心脏事件发生。生存的78例患者出院前测平均LVEF为43%(26%～62%)。结论对于80岁以上高龄老年人AMI患者,直接PCI是一种安全、有效的治疗方法。     

80岁以上高龄患者冠状动脉搭桥术的治疗效果

目的探讨80岁以上高龄患者行冠状动脉搭桥术(CABG)的临床效果及围手术期的处理。方法自2001年6月至2007年2月,我院共为54例80岁以上高龄患者行单纯CABG术,其中男性43例,女性11例,年龄80～99(83.00±5.99)岁。行停跳CABG9例,不停跳CABG(OPCAB)45例。分别行搭桥1～5(2.98±0.46)根。42例患者应用乳内动脉搭桥。结果围术期死亡4例,死亡率为7.41%。术后发生并发症包括低心排综合征5例,呼吸功能不全6例(3例行气管切开),急性肾功能损伤3例(2例行持续性肾脏替代治疗)。术后发生房颤38例。术中及术后应用主动脉内球囊反搏(IABP)3例。平均ICU滞留(3.90±1.96)d,术后平均住院(12.11±4.41)d。46例患者随访1～58个月,随访期死亡9例,93.5%的患者心绞痛症状消失。结论80岁以上高龄患者行CABG术是可行的。对于80岁以上高龄的患者,应加强围术期的处理,以期进一步降低死亡率和并发症的发生率。     

高龄急性冠状动脉综合征患者经皮冠状动脉介入治疗的临床观察

目的评价高龄急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)的效果和预后。方法收集入住本院的61例行PCI术的高龄ACS患者的临床资料,其中男性38例,女性23例,年龄为80~88(82±2)岁。19例行急诊PCI术,42例为择期PCI术,观察近期(住院期间)和远期主要不良心脑血管事件(MACCE)的发生和临床预后。结果61例患者中3支血管病变39例(64%),双支血管病变16例(26%),单支血管病变6例(10%);完全闭塞病变25例(41%);14例(34%)患者合并肾动脉狭窄。手术操作成功率97%,术后心肌梗死溶栓试验3级达97%,术后并发症发生率13%,其中造影剂肾病6例(10%)。住院期间MACCE发生率3%,均为心源性死亡,4个月至4年9个月随访期间MACCE发生率22%,包括3例心脑源性死亡、2例其他原因死亡。结论高龄ACS患者行PCI术手术操作成功率高,住院期间病死率和随访期间MACCE发生率较低,但患者病变重,并发症尤其是造影剂肾病发生率相对较高。     

80岁以上冠状动脉旁路移植术的临床观察

目的:总结80岁以上超高龄患者冠状动脉旁路移植术(CABG)的临床特点和结果。方法:对阜外心血管病医院2003年8月至2013年7月期间,112例行CABG的80岁以上患者的临床资料进行回顾性分析。记录术前一般情况、冠状动脉病变、合并疾病、治疗情况、术中手术方式、术后恢复情况以及并发症和病死率。结果:术前3支病变或合并左主干病变的患者占72%,66%的患者合并高血压,52%高血脂,22%心律失常,31%糖尿病,19%呼吸功能不全,58%不稳定心绞痛,9.8%急性心肌梗死,23%陈旧性心肌梗死,22%脑卒中史。70例患者常温下行CABG术,42例体外循环下行CABG术,其中3例为CABG+室壁瘤切除术。平均旁路移植数量为(2.7±0.6)支。全组死亡3例,围术期心肌梗死2例,延迟苏醒5例,肺部感染8例,机械通气时间延长13例,新发生脑卒中2例,肾替代治疗4例,出血需二次手术6例。结论:80岁以上的超高龄冠心病患者,体外循环和非体外循环CABG均可提供安全有效的治疗效果,对于术前冠状动脉病变程度较重,术中需要再血管化搭桥数量较多、合并室壁瘤切除或其他心脏直视手术的患者,采用体外循环下手术。对于冠状动脉病变适合不停跳条件下就可以充分再血管化的患者,采用非体外循环CABG是适宜的手术方式。     

高龄肺癌的外科治疗

作者对70岁以上95例高龄肺癌患者(其中80岁以上7例)为研究重点,并对手术适应证和预后进行了讨论.以Ⅰ期肺癌最多,为45例(21.5%),其中5例为80岁以上高龄者。69岁以下肺癌者为对照组.高龄组与对照组相比肺叶切除、两叶切除和肺摘馀较少,区域切除和部分切除稍多。术后合并症高龄组为55.8%,主要为咯痰困难、不整脉和肺炎。与术后死亡有关的危重合并症是支气管瘘,肺炎、脓胸、消化道出血、肾功能不全和胸腔出血等.     

80岁以上高龄腹部外科急诊手术患者的特点和治疗策略

本文报道解放军 30 6医院普外科自 1985年 12月至 2 0 0 1年 12月收治的 5 1例 80岁以上高龄腹部外科急诊手术的经验体会 ,以探讨此类患者的临床特点和治疗策略[1] 。分析 5 1例 80岁以上高龄患者腹部外科手术情况。手术种类 :胆道手术 19例 (胆囊切除术 14例 ,胆囊大部切除术 1例 ,胆囊切除、胆总管切开Ｔ管引流术 4例 ) ;直肠癌根治术 2例 ;胰头癌行胆总管、空肠Ｒｏｕｘ Ｙ内引流术 2例 ;胃癌行根治术 3例 ;结肠癌行根治术 6例 ;贲门癌行开胸腹联合切口根治术 1例 ;腹股沟嵌顿疝 5例 ;肠梗阻、肠扭转 5例 ;急性阑尾炎行切除术 7例 ;髂股…     

80岁以上急性心肌梗死患者的急诊冠状动脉介入治疗

目的　评价高龄 (≥ 80岁 )急性心肌梗死 (AMI)患者急诊冠状动脉介入治疗 (PCI)的安全性和近、中期疗效。方法　 1999年 9月至 2 0 0 3年 10月收治的行急诊PCI(<12h)的AMI患者中≥80岁的 2 1例 (高龄组 )和 <6 0岁的 37例 (年轻组 ) ,分析两组基础资料特征、即刻手术成功率和随访期间主要不良心血管事件 (复发性心绞痛、心肌梗死及猝死 )发生率的差异。结果　高龄组心力衰竭及多支病变比例高于年轻组 (分别为 71%vs 16 %和 81%vs35 % ,P均 <0 0 5 ) ,高龄组入院至梗死相关动脉开通时间长于年轻组 [(6 3 6± 17 0 )minvs (5 5 3± 13 0 )min ,P <0 0 5 ]。两组患者急诊PCI成功率均为 10 0 %。住院期间死亡高龄组 2例 ,年轻组 0例。随访 4个月至 4年 ,高龄组发生心绞痛 3例、心肌梗死 2例、猝死 0例 (共占 2 4 % ) ;年轻组发生心绞痛 3例、心肌梗死 0例、猝死 0例 (总计 8% ,P <0 0 5 )。结论　高龄AMI患者急诊PCI成功率高 ,入院至梗死相关动脉开通时间延长 ,围手术期死亡和近、中期主要不良心血管事件发生率较高。     

80岁以上高龄患者行冠状动脉旁路移植术临床疗效分析

目的观察80岁以上患者行冠状动脉旁路移植术(CABG)的临床效果。方法选择2001年10月至2013年10月,在北京军区总医院心血管外科行CABG手术年龄80岁的高龄冠心病患者60例,其中男性53例,女性7例,平均年龄(82.65±2.27)岁。急诊手术5例。体外循环下搭桥(on-pump)6例,非体外循环下搭桥(off-pump)54例。记录患者冠状动脉搭桥数量,围手术期呼吸机辅助呼吸时间、住院时间、重要脏器并发症发生率以及近期心肌缺血事件发生率。结果纳入患者平均搭桥(3.13±0.24)支,术后呼吸机辅助呼吸(10.11±4.37)h,平均住院时间(11.36±4.51)d。围手术期死亡率为5%。并发症发生率依次为胸腔积液(48.3%)、低氧及高碳酸血症(30.0%)、心房颤动(26.7%)、肾功能不全(23.3%)、低心排综合征(5.0%)等。患者出院后随访3个月,均无心肌缺血事件发生。结论做好充分的术前准备、评估及围手术期管理,80岁以上高龄患者的CABG手术依然可以取得良好效果。     

高龄髋部周围骨折359例外科治疗

目的通过对高龄髋部周围骨折病人的前瞻性分析，探讨高龄髋部周围骨折的外科治疗以及意义。方法1997年1月～2003年4月，对我院359例≥80岁髋部周围骨折病人进行围手术处理后，早期予以关节置换或内固定治疗；大部分患者术后第3～5天能扶拐下地或行走。结果325例随访7～25月(平均14．3月)，其中282例(87％优良)恢复生活自理。结论高龄髋部周围骨折应早期由有经验的医务人员进行外科处理，以减少骨折卧床带来的并发症。     

Traitement chirurgical des anévrismes poplités : résultats à court et à long termes

IntroductionThe popliteal artery aneurysm (PAA) is a rare vascular disease, but represents the most common site of peripheral aneurysms. We report in this paper our experience in the surgical management of PAA.ObjectivesThe aim of this work was to clarify the indications and the results of the surgical management of PAA.MethodsIt was a retrospective study, extended over a period of 12 years, going from 2007 to 2018, covering 26 patients operated on surgically for popliteal aneurysm.ResultsWe have operated 26 patients for PAA. All patients were male. The average age was 59 years [39–80 years]. The aneurysm was symptomatic in 22 cases and asymptomatic in 4 cases. The mean aneurysm diameter was 37 mm [26–70 mm]. Twenty-two patients have received a planned surgery and we did emergency surgery for 4 patients because of a limb ischemia complication. The surgical treatment consisted in a surgical bypass after the aneurysm removing. The restoration of blood continuity was achieved by a vein graft in 23 cases and prosthetic in 3 cases. Three patients needed major amputation within 30 days (11.53%) and no mortality was observed during this period. Mean follow-up was 24 months [12–96 months]. Two-years mortality, complication rate and limb salvage was respectively 7.69%, 15.38% and 84.62%.ConclusionThe PAA represents a serious disease that can affect the vitality of the lower limb. Surgical treatment is currently the gold standard because of its good results.     

Severe and distal ischemia of the upper limb. Results of a surgical follow-up of 11 years in 34 patients

The aim of this retrospective study was to evaluate etiology, frequency and prognosis of the distal and severe arterial diseases of the upper limb treated in a vascular surgical unit. Between Jan. 1986 and Jan.1997, 34 patients, 22 males and 12 females, mean age 56 years (range 30 to 87 years) were followed in the vascular and thoracic surgical unit in Angers. Follow-up was 100% complete. Each patient was explored by selective angiography of the upper limb due to the critical characteristic of ischemia.19 patients (56%) had tissue loss. Among multiple etiologies, arteriosclerosis was found in 32% of the cases. When medical treatment was unsuccessful, a thoracic sympathectomy was attempted in 50% of the cases, and 21% of the patients had direct arterial surgery. Nine deaths, due to initial pathology, occurred during follow-up. Eight digitalis amputations were carried out whose two directly because serious necrosis. Severe arterial diseases of the upper limb represented 6, 4% of critical limb ischemia treated during this same period. At time, this study showed arteriosclerosis preponderance over systemic diseases, and the seriousness of cases referred to a vascular surgical center after unsuccessful medical treatment (J Mal Vasc 1999; 24: 368-372).     

In-hospital complications of percutaneous intraaortic balloon counterpulsation

Complications related to intraaortic balloon counterpulsation pumping (IABP) remain a problem despite the development of small caliber balloon catheter shafts and introducer sheaths. The authors report their experience in counterpulsation-related complications of 201 consecutive patients who underwent 212 percutaneous counterpulsation balloon insertions from June 1989 to June 1996 by use of balloons with 8-9.5 French shafts. Of these, 82% were men and 36 (18%) were women, with a mean age of 61 +/-12 years. Indications for counterpulsation were acute myocardial infarction (AMI) (67%), severe left ventricular failure without AMI (20%), dilated cardiomyopathy (4%), unstable angina (3%), high-risk supported percutaneous coronary angioplasty (2%), and others (4%). IABP was instituted at the bedside in the intensive care unit in 82 patients (39%) and in the catheterization laboratory in 130 (61%). Median duration of counterpulsation was 48 hours (range 30 minutes to 25 days) with successful weaning from counterpulsation in 70% (148 of 212) of procedures. Overall in-hospital mortality rate was 45% (90 of 201). The overall complication rate was 22/212 (10.4%). Major complications were present in 10/212 procedures (4.7%): 6 patients with limb ischemia (1 death directly attributed to this complication, 1 with associated septicemia and limb amputation, 3 requiring surgical thromboembolectomy, and 1 with persistent limb ischemia treated medically until his death caused by intractable left ventricular failure), 2 with important bleeding (1 fatal despite vascular surgical repair and 1 requiring blood transfusion) and 2 with balloon rupture requiring vascular surgery. Minor complications were present in 12 procedures (5.7%), 6 with limb ischemia, 3 with local bleeding, and 3 with catheter dysfunction. All of these resolved after balloon removal and required no further intervention. When limb ischemia did develop it occurred after a median delay of 24 hours following balloon insertion (range 2 to 98 hours). The only predictor of limb ischemia among baseline clinical and procedure-related variables was an age greater than 60 years. Compared with previous recent studies, the rate of complications observed in this study performed with small balloon catheters was acceptably low. Limb ischemia was the most frequent complication, often occurred early, and required further intervention in half the cases.     

Valve surgery in octogenarians: a safe option with good medium-term results

BACKGROUND AND AIM OF THE STUDY: The number of octogenarians is increasing in industrialized societies, and many patients aged over 80 years have heart valve disease which is amenable to surgical treatment. The perioperative outcomes and long-term results in very elderly patients undergoing valve surgery were evaluated. METHODS: A retrospective analysis was conducted of 2,791 patients with long-term follow up, who underwent valve surgery between 1990 and 2002. Of these patients, 132 (68 males, 64 females) were aged over 80 years (mean age 82 +/- 2 years; range: 80-94 years). RESULTS: Ninety-five patients (71.9%) underwent aortic valve replacement, 36 (27.3%) mitral surgery, and one patient had double-valve surgery. Sixty-five patients (49.2%) required concomitant coronary artery bypass grafting. There were 11 (8.3%) redo procedures. Patients aged over 80 years were significantly more symptomatic preoperatively than their younger counterparts (NYHA class III-IV 90.9% versus 69.0%, p < 0.001), with more congestive cardiac failure, hypertension, peripheral vascular disease, obstructive pulmonary disease, and renal failure (all p < 0.05). Perioperative mortality did not, however, differ significantly between groups (< 80 years versus > or = 80 years, 2.9% versus 4.6%, p = 0.10). There was also no difference in the composite end point of in-hospital death, renal failure, stroke, low output state, myocardial infarction, or sternal wound infection (< 80 years versus > or = 80 years, 10.5% versus 11.4%, p = 0.8). The mean follow up period was 66 +/- 44 months (< 80 years) versus 61 +/- 37 (> or = 80 years). Late mortality was higher in the elderly group (10-year survival 37.9% versus 68.2%, p < 0.001) and preoperative atrial fibrillation (RR 2.75; CI: 1.44-5.23), coronary artery disease (RR 1.98; CI 1.12-3.52) and congestive cardiac failure (RR 2.13; CI: 1.10-4.11) were independent predictors of late mortality. The groups did not differ with respect to long-term valve-related events, with the exception of fewer reoperations among elderly patients. CONCLUSION: Valve surgery in selected octogenarians is associated with low morbidity and mortality. The outlook after surgery is very good, and surgery should not be denied to this group on the basis of age alone.     

Surgical treatment and prognosis of octogenarians with non-small cell lung cancer

ObjectiveTo explore the clinical characteristics, surgical treatment and prognosis of non-small cell lung cancer (NSCLC) among elderly patients over 80 years.MethodsThe clinical data, surgical methods, perioperative management, postoperative complications and prognosis of 52 NSCLC patients aged over 80 years were retrospectively analyzed.ResultsOut of 52 cases, 27 had a long-term smoking history (51.9%) and 44 were with other diseases (84.6%). Lobectomy was done in 32 cases (65.4%), sub-lobectomy in 20 cases (38.5%), including pulmonary wedge resection in 16 cases (30.8%) and lung segment resection in 4 cases (7.7%). The postoperative complication rate was 44.2% (23/52); the complication rate after lobectomy was 62.5% (20/32) and that after sub-lobectomy was 25% (5/20), with significant difference between lobectomy and sub-lobectomy (P<0.05). Postoperative mortality was 3.8% (2/52). Pathological TNM staging: I a 27 cases (51.9%), I b 12 cases (23.1%), II a 8 cases (15.4%), II b 3 cases (5.8%) and III a 2 cases (3.8%). The 1-, 3- and 5-year survival rate after operation was 87.1%, 59.8%, 19.1%. The 1-, 3- and 5-year survival rate was 86.0%, 61.8%, 21.5% in the patients after lobectomy; that was 89.0%, 58.3%, 18.7% in the patients after sub-lobectomy, with no significant difference between two surgical methods (P>0.05).ConclusionsOctogenarians with NSCLC are often afflicted with comorbidity, so perioperative management is more complex. Strictly adhering to indications, surgery is still an important treatment of NSCLC patients over 80.     

Vascular surgery in a small community hospital: review of 286 consecutive major procedures

From August 1981 to August 1985, 286 major vascular procedures were performed in a small community hospital by one trained vascular surgeon. The procedures were performed in 272 patients, 174 (64%) of whom were men and 98 (36%) of whom were women, with a median age of 66.3 years. The average length of hospital stay was 9.3 days. Two hundred fifty-three (88%) of the cases were elective, and the other 33 (12%) were emergencies. The overall operative mortality was 1.9% (5 out of 253 patients) in the elective group and 27.0% (9 out of 33 patients) in the emergency group. The stroke and mortality rate was 1.2% for elective cerebrovascular procedures. Sixty infrainguinal bypasses were performed, with three early failures and one late failure resulting in major amputation. All failures occurred in the limb salvage group (who had infrapopliteal bypasses and profundoplasty). These data suggest that vascular surgery can be performed safely and adequately in a small community hospital, with results comparable to those of a university hospital, and that vascular surgeons may maintain an adequate level of competence even if they perform fewer than 100 cases per year.     

Surgical management and mid-term outcomes of 108 patients with infective endocarditis

This study evaluates the early and mid-term outcomes, predictors of mortality and morbidity and quality of life of patients operated for infective endocarditis. Data on 108 patients undergoing 113 surgical procedures during October 1998 to January 2010 was prospectively collected. NYHA Class was >III in 49 (43.4%) cases. Thirty-seven (33%) patients had isolated mitral valve procedures, 58 (51%) had aortic valve, two had tricuspid valve and 16 had multivalvular procedures. Active endocarditis was noted in 86 (76%) procedures, native valve endocarditis in 105 (93%) and prosthetic valve endocarditis in eight procedures. Logistic EuroSCORE at presentation was >14 in 18 (17%) patients. Staphylococcus aureus was the most common organism isolated. Follow-up was carried out in 76/85 (88.37%) of surviving patients, and the mean follow-up time was 37.2 months. Functional class and quality of life (using EQ-5D Health Questionnaire) were assessed by telephone interviews. NYHA Class on follow-up was I-II in 62/76 (83%). Multivariate predictor of 30-day mortality was peripheral vascular disease (p = 0.025) whilst multivariate predictors of long-term survival were male sex (p = 0.01), peripheral vascular disease (p = 0.02) and bypass time (p = 0.006). The overall survival was 87% at one year and 80% at five years. Thirty-three percent (25/76) patients reported a score reflecting full health. Optimal antibiotic therapy and timely surgical intervention were associated with improved functional class, quality of life and mid-term survival.     

Results of coronary artery surgery in octogenarians

Over an 11 year period from January 1990 to December 2000, 3282 patients underwent isolated or combined surgical myocardial revascularisation. In this group, 42 were aged 80 or over (maximum 87 years), 1.3% of the total patient population. The mean age of this subgroup was 81.8 +/- 1.75 years) with a male predominance (61.9%). All patients were autonomous and considered to be in good general and psychological health. Preoperative coronary angiography showed 33.3% of left main stem lesions either alone or associated with a right coronary lesion. The ejection fraction was over 50% in 78.6% of cases. Saphenous vein grafts were used in all but 5 patients who also had left internal mammary artery grafts. Thirteen patients (31%) underwent combined valvular surgery (11 aortic and 2 mitral valve) and 2 patients underwent combined vascular surgery. Three patients were operated as an emergency. A total of 5 patients died in the first 30 postoperative days, a hospital mortality of 11.9%. There were 2 postoperative hemiplegias and 2 cases of renal failure which were aggravated in the postoperative period. The other patients were discharged from hospital with a satisfactory cardiac and functional status. The global mortality was 14% at 3 years and 18% at 5 years. The main bad prognostic factor for survival was the association of aortic valve surgery. In selected octogenarians in good general and psychological health without severe co-morbid conditions, surgical myocardial revascularisation may be considered with an acceptable operative risk.     

Early surgical outcome after failed primary stenting for lower limb occlusive disease.

PURPOSE: To evaluate the early results of revascularization after failed primary stent placement for lower limb occlusive disease. METHODS: A retrospective review was conducted of 25 consecutive patients (16 men; mean age 65 years, range 32-89) treated between January 2001 to October 2003 for infrainguinal stent failure at a median 6.6 months (range 3-60) after primary stent implantation (27 femoropopliteal and 20 popliteal-crural) at referring hospitals. All surgical procedures for stent failure were performed at tertiary centers. The results of bypass grafting for failed stenting were compared to a contemporaneous cohort of patients undergoing primary bypass surgery performed by the same surgeons. RESULTS: At the time of admission, 22 stents were thrombosed, and 3 patent stents presented with >50% in-stent stenosis. Twenty patients had 7 femoropopliteal or 9 femorodistal vein bypasses and 4 reconstructions of the common femoral or profunda femoris artery. Four patients had 3 primary amputations and 1 lumbar sympathectomy. One patient with claudication was treated conservatively. Procedure-related complications were observed in 40%; 30-day mortality was 4% (1/25). Early (30-day) graft thrombosis occurred in 6 (30%) of 20 arterial reconstructions, necessitating 8 secondary amputations (44% [11/ 25] overall amputation rate). A total of 47 surgical procedures were performed in the 24 surviving patients (median 2 operations per patient, range 1-9) over an 11-month period (range 1-57). Primary patency rates at 30 days and at 6 and 12 months were 67%, 44%, and 33%, respectively, in the poststent bypass cohort versus 98%, 96%, and 88%, respectively, in a contemporaneous group of patients treated with primary bypass grafting. CONCLUSIONS: Failed stents in lower limb arteries often require distal reconstructive bypass surgery, which is associated with high complication rates and poor outcome, including major amputations. There is no scientific evidence to support stenting below the inguinal ligament.     

Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery

BACKGROUND: Major surgical procedures are performed with increasing frequency in elderly persons, but the impact of age on resource use and outcomes is uncertain. OBJECTIVE: To evaluate the influence of age on perioperative cardiac and noncardiac complications and length of stay in patients undergoing noncardiac surgery. DESIGN: Prospective cohort study. SETTING: Urban academic medical center. PATIENTS: Consecutive sample of 4315 patients 50 years of age or older who underwent nonemergent major noncardiac procedures. MEASUREMENTS: Major perioperative complications (cardiac and noncardiac), in-hospital mortality, and length of stay. RESULTS: Major perioperative complications occurred in 4.3% (44 of 1015) of patients 59 years of age or younger, 5.7% (93 of 1646) of patients 60 to 69 years of age, 9.6% (129 of 1341) of patients 70 to 79 years of age, and 12.5% (39 of 313) of patients 80 years of age or older (P < 0.001). In-hospital mortality was significantly higher in patients 80 years of age or older than in those younger than 80 years of age (0.7% vs. 2.6%, respectively). Multivariate analyses indicated an increased odds ratio for perioperative complications or in-hospital mortality in patients 70 to 79 years of age (1.8 [95% CI, 1.2 to 2.7]) and those 80 years of age or older (OR, 2.1 [CI, 1.2 to 3.6]) compared with patients 50 to 59 years of age. Patients 80 years of age or older stayed an average of 1 day more in the hospital, after adjustment for other clinical data (P = 0.001). CONCLUSIONS: Elderly patients had a higher rate of major perioperative complications and mortality after noncardiac surgery and a longer length of stay, but even in patients 80 years of age or older, mortality was low.