BMJ 1998;317:852-856 ( 26 September )

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Long term relative survival after surgery for abdominal aortic aneurysm in Western Australia: population based study

Paul E Norman, senior lecturer, a James B Semmens, coordinator of quality of surgical care project, b Michael M D Lawrence-Brown, vascular surgeon, c C D'Arcy J Holman, director. b

a University Department of Surgery, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia, b Centre for Health Services Research, Department of Public Health, University of Western Australia, Nedlands, Western Australia 6009, Australia, c Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia 6000, Australia

Correspondence to: Mr Norman pnorman{at}cyllene.uwa.edu.au

Objective: To determine the long term relative survival of all patients who had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. 
Design: Population based study.
Setting: Western Australia.
Subjects: All patients who had had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. 
Main outcome measures: Morbidity and mortality data of patients admitted and surgically treated for abdominal aortic aneurysm in Western Australia during 1985-94. Elective, ruptured, and acute non-ruptured cases were analysed separately. Independent analyses for sex and patients aged 80 years or more were also undertaken. Postoperative (>30 days) relative survival was assessed against age and sex matched controls.
Results: Overall, 1475 (1257 men, 218 women) cases were identified. The crude five year survival after elective surgery, including deaths within 30 days of surgery, was 79% for both men and women. When compared with a matched population the five year relative survival after elective surgery was 94.9% (95% confidence interval 89.9% to 99.9%) for men but only 88.0% (76.3% to 99.7%) for women. The five year relative survival of those aged 80 years and over was good: 116.6% (89.1% to 144.0%) compared with 92.4% (87.7% to 97.0%) for those under 80 years of age (men and women combined). Cardiovascular disease caused 57.8% of the 341 deaths after 30 days.
Conclusion: In a condition such as abdominal aortic aneurysm, which occurs in elderly patients, relative survival is more clinically meaningful than crude survival. The five year relative survival in cases of elective and ruptured abdominal aortic aneurysm was better in men than in women. This is probably because of greater comorbidity in women with abdominal aortic aneurysm and this deserves more attention in the future. The long term survival outcome in octogenarians supports surgery in selected cases.

Key messages

  • Background mortality for conditions such as abdominal aortic aneurysm in elderly patients needs to be taken into account when assessing long term survival after surgery

  • Relative survival methodology can correct for background mortality

  • The five year relative survival for patients surviving beyond 30 days of elective surgery for abdominal aortic aneurysm was 95% for men and 88% for women

  • For octogenarians, five year survival after elective surgery was greater than that expected of an age matched population

  • Age over 80 years should not preclude consideration for elective surgery for abdominal aortic aneurysm



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