The effect of age on short-term outcomes after pancreatic resection: a population-based study

Abstract

Objective: To use a large population-based cohort to determine age-dependent short-term outcomes after pancreatic resection.

Methods: We identified all pancreatic resections in Texas from 1999 to 2005. Patients were stratified into 4 age groups (<60, 60-69, 70-79, and 80+ years). Bivariate and multivariate analyses were performed to determine the effect of age on mortality, discharge to home versus requiring inpatient nursing care, and length of stay.

Results: Three thousand seven hundred and thirty-six patients underwent pancreatic resection. Unadjusted in-hospital mortality increased with each increasing age group from 2.4% in patients <60 to 11.4% in patients 80 years and older (P < 0.0001). Likewise, postoperative lengths of stay increased with each increasing age group (P = 0.02). Age group independently predicted the need for discharge to an inpatient nursing unit rather than home (P < 0.0001), with the odds ration (OR) increasing with each increasing age group. With each increasing age group, patients were less likely to be resected at high-volume (H-V) hospitals (>10 pancreatic resections/y). Whereas low-volume (L-V) hospitals (< or =10 pancreatic resections/y) had higher mortality rates (3.2% versus 7.3%, P < 0.0001), the difference in mortality between H- and L-V hospitals was more striking in older patients. With increasing age group, mortality increased from 3.0% to 9.5% to 11.4% to 14.7% at L-V hospitals. It increased from 2.0% to 3.5% to 4.5% to 8.7% at H-V hospitals (P < 0.0001). In the multivariate model controlling for gender, race, hospital volume, year of surgery, diagnosis, risk of mortality, severity of illness, admission status, and procedure type, older age group independently predicted increased mortality. The OR for patients 60-69 years was 2.5 (P = 0.0003), the OR for patients 70-79 years was 1.8 (P = 0.02), and the OR for patients 80+ years was 4.4 (P < 0.0001) when compared with patients <60 years.

Conclusions: In contrast to some previous single-institution studies, we found that increased age is an independent risk factor for mortality after pancreatic resection. For all ages, mortality rates were higher at L-V hospitals, but the difference worsened significantly with increasing age. Older patients had longer lengths of stay, were less likely to be discharged home, and more likely to require care at an inpatient nursing or acute care facility at the time of discharge.

FIGURE 1

A. This bar graph represents the distribution of “risk of mortality” score within each age group category. The 4 possible scores are represented by different color bars (1 = black, 2 = gray, 3 = white, and 4 = striped). The x-axis shows the age group and the y-axis shows the percentage of patients with a particular score. For each age category, the 4 different color bars add up to 100%. With increasing age, the distribution of scores is shifted toward higher mortality risk. B. This bar graph represents the distribution of “illness severity” score within each age group category. The 4 possible scores are represented by different color bars (1 = black, 2 = gray, 3 = white, and 4 = striped). The x-axis shows the age group and the y-axis shows the percentage of patients with a particular score. For each age category, the 4 different color bars add up to 100%. With increasing age, the distribution of scores is shifted toward illness severity.