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The effect of age on short-term outcomes after pancreatic resection: a population-based study
Taylor S Riall1, Deepthi M Reddy, William H Nealon
1Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542, USA. tsriall@utmb.edu
Insights
Older age independently increases mortality risk after pancreatic resection. Outcomes like longer hospital stays and discharge to nursing facilities also worsen with increasing age.
Area of Science:
- Surgical Oncology
- Geriatric Surgery
- Health Services Research
Background:
- Pancreatic resection is a complex procedure with significant morbidity and mortality.
- Previous studies on age-related outcomes have yielded mixed results, often from single institutions.
- Understanding age-dependent outcomes is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate the association between patient age and short-term outcomes following pancreatic resection.
- To identify age as an independent risk factor for mortality and other adverse events after pancreatic surgery.
Main Methods:
- A population-based cohort of pancreatic resections in Texas (1999-2005) was analyzed.
- Patients were stratified into four age groups: <60, 60-69, 70-79, and 80+ years.
- Bivariate and multivariate analyses assessed the impact of age on mortality, discharge disposition, and length of stay, controlling for various clinical factors.
Main Results:
- In-hospital mortality increased significantly with each advancing age group, from 2.4% (<60) to 11.4% (80+).
- Older age independently predicted increased mortality (ORs ranging from 1.8 to 4.4 compared to <60 group).
- Older patients experienced longer postoperative lengths of stay and were less likely to be discharged home, with higher rates of discharge to inpatient nursing facilities.
Conclusions:
- Advanced age is an independent risk factor for mortality after pancreatic resection.
- Mortality rates were higher at low-volume hospitals, with this disparity becoming more pronounced in older patients.
- Older patients have poorer short-term outcomes, including increased mortality, prolonged hospitalization, and higher rates of post-discharge institutional care.
Objective:
To use a large population-based cohort to determine age-dependent short-term outcomes after pancreatic resection.
Methods:
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.
Results:
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.
Conclusions:
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.
