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Meta-Analysis
. 2012 Oct;14(10):649-57.
doi: 10.1111/j.1477-2574.2012.00506.x. Epub 2012 Jun 27.

Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review

Prashant Sukharamwala  1 , Jonathan Thoens, Mauricio Szuchmacher, James Smith, Peter DeVito
Affiliations
Meta-Analysis

Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review

Prashant Sukharamwala et al. HPB (Oxford). 2012 Oct.

Erratum in

  • HPB (Oxford). 2012 Dec;14(12):877. Prashant, Sukharamwala [corrected to Sukharamwala, Prashant]; Jonathan, Thoens [corrected to Thoens, Jonathan]; Mauricio, Szuchmacher [corrected to Szuchmacher, Mauricio]; James, Smith [corrected to Smith, James]; Peter, DeVito [corrected to DeVito, Peter]

Abstract

Background: The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (≥75 and ≥80 years of age).

Methods: A systematic literature search was conducted using Embase, MEDLINE, Cochrane and PubMed databases on all studies published between January 1990 and April 2012 reporting peri-operative outcomes after a pancreaticoduodenectomy (PD) among the elderly. Primary end-points measured were peri-operative mortality and the incidence of post-operative complications. Secondary outcomes considered included the incidence of post-operative pancreatic fistula formation (POPF), delayed gastric emptying (DGE), wound infection, pneumonia, post-operative bleeding and length of hospital stay.

Results: Eleven trials were included comprising 5186 patients; 7 studies comparing endpoints in patients aged ≥75 years vs. younger populations and 4 studies comparing endpoints in patients aged ≥80 years vs. younger populations. In both groups, there was a statistically significant increase in the incidence of mortality and post-operative pneumonia in the elderly population. The incidence of post-operative complications was also found to be statistically significant among patients ≥80 years of age vs. their younger cohorts.

Conclusions: There is an increased incidence of post-operative mortality and pneumonia after a PD among all elderly patients ≥75 years of age, as well as an increased incidence of post-operative complications among patients ≥80 years of age. Additional randomized control trials studying post-PD operative outcomes in elderly vs. younger patients with standardization of comorbidities is therefore necessary to confirm the conclusions presented here.

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Figures

Figure 1
Figure 1
Study flow diagram in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement
Figure 2
Figure 2
Funnel plot (mortality in elderly ≥75 years of age)
Figure 3
Figure 3
Funnel plot (mortality in elderly ≥80 years of age)
Figure 4
Figure 4
Forest plot of comparison of post-operative mortality in elderly ≥75 years of age
Figure 5
Figure 5
Forest plot of comparison of post-operative mortality in elderly ≥80 years of age
Figure 6
Figure 6
Forest plot of comparison of post-operative pneumonia in elderly ≥75 years of age
Figure 7
Figure 7
Forest plot of comparison of post-operative pneumonia in elderly ≥80 years of age
Figure 8
Figure 8
Forest plot of comparison of post-operative complications in elderly ≥80 years of age
Figure 9
Figure 9
Forest plot of comparison of post-operative complications in elderly ≥75 years of age
See this image and copyright information in PMC

Comment in

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