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Early postoperative outcomes after pancreaticoduodenectomy in the elderly.

BACKGROUND
Single-institution case series suggest that elderly patients do as well as younger patients after pancreaticoduodenectomy.


OBJECTIVES
To compare morbidity and mortality after pancreaticoduodenectomy in patients older than 70 years vs younger patients.


HYPOTHESIS
Elderly patients have worse 30-day outcomes.


DESIGN
Retrospective cohort study.


SETTING
American College of Surgeons-National Surgical Quality Improvement Program hospitals.


PATIENTS
All patients who had a pancreaticoduodenectomy from January 1, 2005, to December 31, 2007, were identified.


METHODS
Multiple logistic regression models were developed to assess the association between age and 30-day outcomes.


MAIN OUTCOME MEASURES
Thirty-day postoperative morbidity and mortality.


RESULTS
Of the 2610 patients identified, 977 (37.4%) were elderly and 1633 (62.6%) were younger. Overall morbidity was 36.5%. Elderly patients had a higher likelihood of developing at least 1 morbidity (surgical site infection, wound disruption, outpatient pneumonia, unplanned intubation, pulmonary embolism, prolonged ventilation, acute renal failure, urinary tract infection, stroke, cardiac arrest, deep venous thrombosis, sepsis, or return to the operating room) compared with that of younger patients (40.7% vs 34.0%; odds ratio, 1.27; 95% confidence interval, 1.06-1.51; P = .01). Overall mortality was 2.7%. Elderly patients had a higher likelihood of mortality compared with that of younger patients (4.3% vs 1.7%; adjusted odds ratio, 2.01; 95% confidence interval, 1.18-3.43; P = .01). In patients who had at least 1 morbidity, mortality was 10.1% in the elderly compared with 4.1% in the younger patients (P = .002).


CONCLUSIONS
Advanced age is independently associated with morbidity and death following pancreaticoduodenectomy. In addition, the elderly have a higher mortality after a complication compared with that of younger patients, suggesting that advanced age may have a role in "failure to rescue."