Carotid endarterectomy in the elderly: A population-based analysis

Carotid endarterectomy (CEA) has been shown to reduce future stroke risk in select patients but whether the benefit of surgery extends to elderly patients is uncertain. The goal of this study was to determine the influence of elderly patient age on the results of CEA in a population-based analysis. We performed a retrospective cohort study of all patients undergoing CEA by multiple surgeons in our city over an 18 month period. Patients were stratified dichotomously according to age; elderly age was defined as age greater than 75 years at time of operation. Sixty-one elderly patients, who comprised 21% of the study population of 291 cases, more frequently had a history of coronary heart disease and renal insufficiency than their younger counterparts (p < 0.05). Although statistically insignificant, elderly patients had a higher rate of postoperative stroke or death than their younger counterparts (6.6% vs. 4.8%, respectively, p = 0.5). Asymptomatic aged patients suffered postoperative strokes or deaths at a particularly high rate (13%). Elderly patients developed postoperative cardiac complications significantly more often than younger patients (18% vs. 7%, p = 0.006). Elderly patients have a significantly higher risk of cardiac complication, but not stroke or death, after CEA than younger patients, possibly due to associated risk factors for atherosclerosis. Our high rate of postoperative complications in asymptomatic elderly patients suggests they may not have benefited from CEA in our geographic region.