Risk by indication for pancreaticoduodenectomy in patients 80 years and older

a study from the American College of Surgeons National Surgical Quality Improvement Program

John R. Bergquist, Christopher R. Shubert, Daniel S. Ubl, Cornelius A. Thiels, Michael L. Kendrick, Mark Truty, Elizabeth B Habermann

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and ≥80 years) who underwent PD from January 1, 2005, through December 31, 2012. High- and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes. Results Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (≥80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients ≥80 years with low-risk diagnoses. Conclusion In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication. Patients should receive preoperative counseling about their risk.

Original languageEnglish (US)
Pages (from-to)900-907
Number of pages8
JournalHPB
Volume18
Issue number11
DOIs
StatePublished - Nov 1 2016

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Pancreaticoduodenectomy
Quality Improvement
Surgical Wound Infection
Mortality
Duodenal Neoplasms
Bile Duct Neoplasms
Neuroendocrine Tumors
Chronic Pancreatitis
Pancreatic Neoplasms
Counseling
Length of Stay

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Risk by indication for pancreaticoduodenectomy in patients 80 years and older : a study from the American College of Surgeons National Surgical Quality Improvement Program. / Bergquist, John R.; Shubert, Christopher R.; Ubl, Daniel S.; Thiels, Cornelius A.; Kendrick, Michael L.; Truty, Mark; Habermann, Elizabeth B.

In: HPB, Vol. 18, No. 11, 01.11.2016, p. 900-907.

Research output: Contribution to journalArticle

Bergquist, John R. ; Shubert, Christopher R. ; Ubl, Daniel S. ; Thiels, Cornelius A. ; Kendrick, Michael L. ; Truty, Mark ; Habermann, Elizabeth B. / Risk by indication for pancreaticoduodenectomy in patients 80 years and older : a study from the American College of Surgeons National Surgical Quality Improvement Program. In: HPB. 2016 ; Vol. 18, No. 11. pp. 900-907.
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abstract = "Background Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5{\%} in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and ≥80 years) who underwent PD from January 1, 2005, through December 31, 2012. High- and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes. Results Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (≥80 y) undergoing PD was 6.1{\%} for those with high-risk diagnoses vs 4.5{\%} for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients ≥80 years with low-risk diagnoses. Conclusion In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication. Patients should receive preoperative counseling about their risk.",
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N2 - Background Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and ≥80 years) who underwent PD from January 1, 2005, through December 31, 2012. High- and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes. Results Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (≥80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients ≥80 years with low-risk diagnoses. Conclusion In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication. Patients should receive preoperative counseling about their risk.

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