Age-Related Morbidity and Mortality with Cytoreductive Surgery

Cytoreduction and intraperitoneal chemotherapy (IPC) are increasingly considered in older patients. We sought to better characterize the influence of age on 30-day outcomes following this procedure.

The ACS NSQIP database was queried for patients who underwent IPC and a concurrent intra-abdominal operation (2005-2012). Thirty-day death and serious morbidity (DSM) was the primary outcome. Trends in DSM by age were defined using Joinpoint regression. Univariate and multivariate logistic regression identified factors associated with DSM.

In 1085 patients, DSM increased at a significant rate after age 50 (0.6 %/year, p = 0.001). Patients ≥60 (n = 376) represented 35 % of the study population. Age ≥60 years was independently associated with DSM (odds ratio [OR] 1.6, p = 0.001). The older patient population (≥60 years) experienced 44 % morbidity and 3.2 % mortality. In these patients, preoperative weight loss, low preoperative albumin, splenectomy, intraoperative transfusion, contaminated or dirty wound classification, and prolonged operative time were all independently significantly associated with increased DSM. In the absence of these factors (n = 45), the DSM rate was 11 %. Rates of DSM increased to 33, 63, and 100 % in patients with 1 factor, 2-3 factors, and 4 or more factors (n = 14; p < 0.001), respectively. Venous thromboembolism, sepsis, postoperative bleeding, and respiratory complications were significantly more common among those aged 60 years and older (p < 0.05 each).

The risk of DSM increases with age in patients undergoing cytoreduction and IPC. Risk can be stratified using a limited number of patient and operative characteristics.