27 - Freie Mitteilung
15. Mai 2019, 15:30 - 17:00, Bellavista 2, 6. OG
The impact of patient age on postoperative outcomes and treatment costs following pancreatic surgery
A. Andreou, T. Haltmeier, M. Worni, D. Candinas, B. Gloor, Presenter: A. Andreou (Bern)
As life expectancy is increasing, elderly patients are evaluated more frequently for resection of pancreatic lesions. However, the impact of age on postoperative morbidity, mortality and treatment costs in octogenarian patients (≥80 years) undergoing major pancreatic surgery needs further investigation.
Clinicopathological data of patients who underwent pancreatic surgery between 2015 and 2018 in a major hepatopancreatobiliary center in Switzerland were assessed. Postoperative outcomes and hospital treatment costs of octogenarians and younger patients were compared in univariate and multivariate analysis.
During the study period, 331 patients underwent pancreatic resection. Pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy and other procedures were performed in 53%, 20%, 13%, and 14% of patients, respectively. Postoperative morbidity rate and in-hospital mortality rate were 21.8% and 2.7%, respectively. A total of 35 patients were ≥80 years old and 288 patients were <80 years old. The majority of octogenarians suffered from ductal adenocarcinoma, whereas among younger patients other indications were predominant (ductal adenocarcinoma: 66% vs. 39%, P=0.003). Age ≥80 years was associated with a trend towards higher postoperative (31% vs. 21%, P=0.142) and major postoperative complications (29% vs. 17%, P=0.079). However, differences were not statistical significant. Postoperative in-hospital mortality was significantly higher in octogenarians (11.4% vs. 1.7%, P<0.0001). This finding may be explained by the higher grade C pancreatic fistula rate requiring revision surgery in the older age group (11% vs. 2%, P=0.011). In multivariate logistic regression analysis, patient age ≥80 years predicted postoperative mortality independently of the tumour entity and surgical technique (P<0.0001, OR 12.041, 95 % CI 3.46–41.89). Increased major postoperative morbidity was responsible for higher treatment costs and lower cost recovery in octogenarians (93% vs. 106%, P=0.041).
Patient age ≥80 years is associated with increased postoperative morbidity after major pancreatic surgery leading to higher treatment costs and a lower chance for successful resuscitation in patients requiring revision surgery. In octogenarian patients suffering from pancreatic tumours, careful patient selection is therefore crucial to achieve best postoperative and oncologic outcomes.