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Defining “The Elderly” Undergoing Major Gastrointestinal Resections: Receiver Operating Characteristic Analysis of a Large ACS-NSQIP Cohort
Ashwin A Kurian*1, Lian Wang*2, Gary Grunkemeier*2, Neil H Bhayani*1, Lee L Swanstrom3
1Providence Portland Cancer Center, Portland, OR;2Medical Data Research Center, Providence Health & Services, Portland, OR;3Oregon Clinic GMIS Division, Portland, OR

OBJECTIVE(S):
"The Elderly" is poorly defined. Investigators use varying subjectively determined age cut-offs to report outcomes in the elderly. We setout to use objective outcomes data to determine the "at-risk" elderly population.
METHODS:
Patients:
129,331 patients identified from the ACS-NSQIP database (2005 to 2010), undergoing major gastrointestinal resections.
Outcome :
Mortality
Statistical Methods:
Locally weighted regression was used to fit the trend line of mortality over age. Receiver Operating Characteristic (ROC) analysis was used to identify the “predictive age” for mortality.
RESULTS:
Mortality increases with age, with a non-linear transition zone (ages of 50-75 yrs) flanked by two linear zones on either end. The younger linear zone showed low mortality increase (0.5% per decade). Larger mortality increase with age (5.3% per decade) was observed at the older age end. Similar patterns were observed for large volume surgical subtypes, with clustering of “critical age” beyond which mortality increases dramatically at 75 + 2 years (Table). ROC analysis identified the “predictive age” for mortality being 68.5 yrs (AUC=0.72, sensitivity 66.6% and specificity 65.5%).
CONCLUSIONS:
68.5 years is predictive of mortality, with steep increase beyond 75 years. These ages should be used to standardize outcome data and focus perioperative resources to improve outcomes.
Age and Mortality
InterventionNCritical Age(years)Predictive Age (years)SpecificitySensitivityArea under Curve
All Resections129,3317568.565.5 %66.6 %0.72
Elective111,6207666.561.5 %71.9%0.72
Emergent17,71073nanana<0.70
Colectomy101,2587668.565%68.5%0.73
-Total Colectomy75037466.573.569.50.79
-Partial Colectomy93,7557770.568.464.70.72
-Open Colectomy68,1637568.563.667.90.71
Laparoscopic Colectomy33,0957671.573.971.20.79
Gastrectomy57017768.563.6700.72

Age and Mortality(contd)
InterventionNCritical Age (years)Predictive Age (years)SpecificitySensitivityArea under Curve
Whipple1264476nanana<0.70
Hepatectomy7636nananana<0.70
Esophagectomy2092nananana<0.70


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