Hata M et al. (2008) Should emergency surgical intervention be performed for an octogenarian with type A acute aortic dissection? J Thorac Cardiovasc Surg 135: 1042–1046

The outcomes of emergency surgery in elderly individuals require careful consideration; as populations age, this area of practice remains controversial. Hata et al. assessed the prognosis of 58 octogenarian patients (38 female) with type A acute aortic dissection (mean age 83.2 years). Surgery was recommended to all patients, 30 of whom consented to undergo the procedure; the other 28 patients were treated conservatively with intravenous antihypertensive medications and low-dose catecholamine.

Initial outcomes of surgically treated patients were better than those of conservatively managed patients: 30-day mortality was 13.3% in the surgical patients versus 60.7% in the medical patients (P = 0.0003). Although the aortic replacement was successful, however, five surgically treated patients became bedridden due to postoperative complications such as cerebral damage and depression. Understandably, in these cases, the families complained to the surgeon and refused to pay for the surgery. The families of pharmacologically treated surviving patients made no complaints. Kaplan–Meier analysis showed no significant difference in actuarial 5-year survival between the treatment groups (48.5% vs 35.4%, respectively).

Hata and colleagues conclude that it is essential for families of elderly patients to be fully informed of all possible outcomes of surgery in order to reach a consensus with the surgeon. In this high-risk group, even successful surgery can be followed by neurologic complications and depression. Although life-saving surgical intervention is of undeniable value, the patient's postoperative quality of life must also be considered.