American Surgical Association

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Topic: H. Quality of Life Outcomes Analysis (clinical and/or financial)

The Effect of Age on Short-term Outcomes After Pancreatic Resection: A Population-based Study

Taylor S Riall, Deepthi M Reddy, William H Nealon
University of Texas Medical Branch, Galveston, TX

Objective: To use a large population-based cohort to determine age-dependent short-term outcomes following pancreatic resection.
Methods: We identified all pancreatic resections in Texas from 1999-2005. Patients stratified into four age groups (<60, 60-69, 70-79, and 80+ years). Bivariate and multivariate analyses were performed to determine the effect of age on mortality and discharge to a skilled nursing facility (SNF).
Results: 3,736 patients underwent pancreatic resection. Results by age group are shown in the table. Mortality was higher in older patients and they were more likely to require a SNF at discharge. Low-volume (LV) hospitals (<11/year) had higher mortality rates, but the difference in mortality between high (HV) and LV hospitals was more striking in older patients. With increasing age group, mortality increased from 3.0% to 9.5% to 11.4% to 14.5% at LV hospitals. It increased from 2.0% to 3.5% to 4.5% to 8.7% at HV hospitals. In the multivariate model, older age group independently predicted increased mortality. The OR for patients 70-79 was 1.8 (P=0.02) and the OR for patients 80+ was 4.3 (P<0.0001) when compared to patients <60.
Table 1
<60 years (N=1780)60-69 years (N=887)70-79 years (N=855)80+ years (N=214)P-value
Periampullary Cancer44%68%72%74%<0.0001
Resected at HV Hospital62%62%57%54%0.01
In-Hospital Mortality2.4%5.8%7.4%11.4%<0.0001
Discharge to a SNF17%23%39%51%<0.0001
Length of Stay (median)11 days13 days14 days15 days0.02

Conclusions: Contrary to previous single-institution studies, increased age is an independent risk factor for mortality following pancreatic resection. For all ages, mortality rates were higher at LV hospitals, but the difference worsened with increasing age. Older patients are more likely to require discharge to a SNF.

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