Functional status determines postoperative outcomes in elderly patients undergoing hepatic resections

Area of Science:

• Hepatobiliary Surgery
• Geriatric Medicine
• Surgical Outcomes Research

Background:

• Increasing incidence of hepatic malignancies in the aging population necessitates evaluation of surgical safety.
• Hepatic resection is a critical treatment for liver tumors, but its safety in elderly patients requires thorough investigation.

Purpose of the Study:

• To assess early postoperative morbidity and mortality in elderly patients undergoing hepatic resection.
• To compare complication rates and mortality between patients aged ≤ 70 years and ≥ 70 years.

Main Methods:

• Retrospective analysis of the National Surgical Quality Improvement Program Participant User Files (NSQIP-PUF) from 2005-2009.
• Inclusion of all patients undergoing hepatic resection, with age categorized as ≤ 70 years or ≥ 70 years.
• Primary outcome measures included 30-day postoperative mortality, overall complication rate, and serious complication rate.

Main Results:

• Elderly patients (≥ 70 years) exhibited significantly higher 30-day postoperative mortality (4.5% vs. 1.9%) and serious complication rates (18.4% vs. 15.2%).
• Overall complication rates were also higher in the elderly group (26.6% vs. 23.1%), with increased instances of wound infections, pneumonia, renal failure, and cardiac events.
• Elderly patients experienced longer hospitalizations and a greater need for prolonged ventilator support and re-intubations.

Conclusions:

• Hepatic resection in elderly patients is associated with significantly increased rates of complications and mortality.
• These findings underscore the importance of carefully weighing the risks and benefits when considering hepatectomy for older individuals.