Outcome after vascular surgery in the ageing

PhD ceremony: Mr. R.A. Pol, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Outcome after vascular surgery in the ageing

Promotor(s): prof. C.J.A.M. Zeebregts

Faculty: Medical Sciences

Life expectancy in the western world is increasing dramatically, and as a result the population is expanding and getting older. Elderly requiring surgery are also a growing population. They present with more comorbidities and less physiological reserve compared with younger patients. Subsequently, we are increasingly confronted with the specialized care that elderly patients require. Although advances in medical care have contributed to improved outcomes in this vulnerable group, there are still age-dependent factors that need attention. In this thesis we show that elderly patients in many cases are still eligible for vascular surgery. However, when dealing with frail and elderly patients with an already limited life expectancy, it is important to weigh the risks of the procedure with the expected outcome. Further, considering the effects on the quality of life is extremely important in elderly patients. Our studies show that quality of life is preserved both after a ruptured abdominal aneurysm and elective endovascular aneurysm repair.

This thesis also contributes to the growing understanding of the pathophysiology of postoperative delirium. Postoperative delirium is a common and serious complication of surgery. Not only does it affect approximately 11-24% of elderly patients upon hospital admission, it is also associated with longer hospitalization and institutionalization, higher medical costs, persistent functional decline and even death. Our results offer tools for either preventing or predicting the occurrence of postoperative delirium. In conclusion, most elderly patients are still eligible for vascular surgery. Advanced age alone is not a reason to refrain from further treatment.