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Increasing age is a predictor of short-term outcomes in esophagectomy: a propensity score adjusted analysis
Christopher C Stahl1, Dennis J Hanseman, Koffi Wima
1Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, 234 Goodman St, ML 0772, Cincinnati, OH, 45219, USA.
Background:
Esophagectomy is a high-risk surgical procedure. As the population ages, more elderly candidates are being evaluated for esophagectomy. The effects of patient age on outcomes after esophagectomy need to be evaluated.
Study Design:
We identified all nonemergent esophagectomies in patients at least 18 years of age within the University HealthSystems Consortium Clinical Database/Resource Manager from 2009 to 2012. Using univariate and multivariate methods, the impact of increasing age on outcomes was analyzed. Additionally, propensity scoring was used to match patients to further investigate the effect of age on the stated outcomes.
Results:
Increasing age is associated with increased mortality (p < 0.001), length of stay (p < 0.001), discharge to rehabilitative care (p < 0.001), and cost (p < 0.001). The effects of age on mortality (8.0 vs 4.2 %, p = 0.03) and discharge to rehabilitative care (44.1 vs 23.4 %, p < 0.01) were confirmed using propensity scoring, comparing patients above 80 with those age 70-79.
Conclusions:
Increasing age has a significant impact on outcomes following esophagectomy, particularly mortality and discharge disposition. Compared to patients under age 80, patients at least 80 years of age considering esophagectomy should be recognized as a high-risk cohort, and these patients must be carefully risk-stratified, counseled, and selected for surgical intervention to prevent unnecessary hospitalization and mortality.
