The Effect of Age on Short-term Outcomes After Pancreatic Resection

Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542, USA.
Annals of surgery (Impact Factor: 8.33). 09/2008; 248(3):459-67. DOI: 10.1097/SLA.0b013e318185e1b3
Source: PubMed


To use a large population-based cohort to determine age-dependent short-term outcomes after pancreatic resection.
We identified all pancreatic resections in Texas from 1999 to 2005. Patients were stratified into 4 age groups (<60, 60-69, 70-79, and 80+ years). Bivariate and multivariate analyses were performed to determine the effect of age on mortality, discharge to home versus requiring inpatient nursing care, and length of stay.
Three thousand seven hundred and thirty-six patients underwent pancreatic resection. Unadjusted in-hospital mortality increased with each increasing age group from 2.4% in patients <60 to 11.4% in patients 80 years and older (P < 0.0001). Likewise, postoperative lengths of stay increased with each increasing age group (P = 0.02). Age group independently predicted the need for discharge to an inpatient nursing unit rather than home (P < 0.0001), with the odds ration (OR) increasing with each increasing age group. With each increasing age group, patients were less likely to be resected at high-volume (H-V) hospitals (>10 pancreatic resections/y). Whereas low-volume (L-V) hospitals (< or =10 pancreatic resections/y) had higher mortality rates (3.2% versus 7.3%, P < 0.0001), the difference in mortality between H- and L-V hospitals was more striking in older patients. With increasing age group, mortality increased from 3.0% to 9.5% to 11.4% to 14.7% at L-V hospitals. It increased from 2.0% to 3.5% to 4.5% to 8.7% at H-V hospitals (P < 0.0001). In the multivariate model controlling for gender, race, hospital volume, year of surgery, diagnosis, risk of mortality, severity of illness, admission status, and procedure type, older age group independently predicted increased mortality. The OR for patients 60-69 years was 2.5 (P = 0.0003), the OR for patients 70-79 years was 1.8 (P = 0.02), and the OR for patients 80+ years was 4.4 (P < 0.0001) when compared with patients <60 years.
In contrast to some previous single-institution studies, we found that increased age is an independent risk factor for mortality after pancreatic resection. For all ages, mortality rates were higher at L-V hospitals, but the difference worsened significantly with increasing age. Older patients had longer lengths of stay, were less likely to be discharged home, and more likely to require care at an inpatient nursing or acute care facility at the time of discharge.

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Available from: James S Goodwin, Jul 02, 2014
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    • "Similarly, although large population-based studies in the pancreatic literature suggest worse short-term outcomes in older, compared to younger, patients [74, 75], it is likely that “age” in these population-based studies was simply a surrogate for chronic illness. When large series of elderly patients undergoing major pancreatic and hepatobiliary operations are analyzed, chronological age turns out not to be a meaningful risk factor, although all agree that physiologic age as described above is essential to consider [76–80]. "
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    ABSTRACT: The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.
    The Scientific World Journal 01/2012; 2012(7):303852. DOI:10.1100/2012/303852 · 1.73 Impact Factor
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    • "Reported data suggest increased perioperative morbidity and mortality risks following pancreatic surgery in older patients [15,27-29]; bathe et al [28] have shown an increased risk for immediate postoperative mortality (within 30 days) in patients older than 75 years, whereas Muscari and Riall [15,28] have demonstrated increased overall complications rate in pancreatic cancer octogenarians. The median age for the present elderly cohort was 75 years (range, 70-87) and more than half of the patients had ASA scores ≥ 3. Nevertheless, our data demonstrate that early postoperative outcomes for patients older than 70 years are comparable to previously published younger cohorts, which has also been reported by others [6,13,14,30,31]. "
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    ABSTRACT: Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery. The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ≥ 70 years were compared to a younger cohort (<70 y). Of 460 patients who had surgery for pancreatic neoplasm, 166 (36%) aged ≥ 70 y. Compared to patients < 70 y (n = 294), elderly patients had more associated comorbidities; 72% vs. 43% (p = 0.01) and a higher rate of malignant pathologies; 73% vs. 59% (p = 0.002). Operative time and blood products consumption were comparable; however, elderly patients had more post-operative complications (41% vs. 29%; p = 0.01), longer hospital stay (26.2 vs. 19.7 days; p < 0.0001), and a higher incidence of peri-operative mortality (5.4% vs. 1.4%; p = 0.01). Multivariable analysis identified age ≥ 70 y as an independent predictor of shorter disease-specific survival (DSS) among patients who had surgery for pancreatic adenocarcinoma (n = 224). Median DSS for patients aged ≥ 70 y vs. < 70 y were 15 months (SE: 1.6) vs. 20 months (SE: 3.4), respectively (p = 0.05). One, two, and 5-Y DSS rates for the cohort of elderly patients were 58%, 36% and 23%, respectively. Properly selected elderly patients can undergo pancreatic resection with acceptable post-operative morbidity and mortality rates. Long term survival is achievable even in the presence of adenocarcinoma and therefore surgery should be seriously considered in these patients.
    World Journal of Surgical Oncology 01/2011; 9(1):10. DOI:10.1186/1477-7819-9-10 · 1.41 Impact Factor
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    ABSTRACT: Although the mortality rates for pancreaticoduodenectomy have been reported to be low for periampullary tumors at high-volume centers, postoperative results still remain unclear for elderly patients over 80 years of age. This was a retrospective study of patients who underwent a pancreaticoduodenectomy and consisted of 335 patients who were treated for periampullary tumors between January 1994 and August 2008. The main outcomes were postoperative complications, mortality, and the length of hospital stay among the elderly patients, and they were analyzed in three groups: elderly patients over 80 years old, septuagenarians, and those under 70 years of age. The performance status of elderly patients was lower than that of the patients under 70 (P < 0.05), and the elderly had a higher American Society of Anesthesiologists physical status classification score (P < 0.001) as well as low hemoglobin and serum albumin levels (P < 0.01 and P < 0.001, respectively). The incidence of delayed gastric emptying in the elderly was higher; however, there was no significant difference. The other outcomes in the elderly group were similar to those of the other groups. Pancreaticoduodenectomy was considered to be a feasible surgical procedure for elderly patients who had a good performance status.
    Journal of Hepato-Biliary-Pancreatic Surgery 05/2009; 16(5):675-80. DOI:10.1007/s00534-009-0106-6 · 1.60 Impact Factor
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