Pancreatic resection in the elderly.
BACKGROUND
Elderly patients undergoing pancreatic resection present unique challenges in postoperative care. Although mortality rates among elderly patients after pancreatectomy at high-volume centers is known to be low, the anticipated decline in functional status and nutritional parameters has received little attention. Functional decline is an unrecognized but critically important consequence of pancreatic resection in older patients.


METHODS
This study is a retrospective review, validation cohort, of older and younger patients undergoing major pancreatic resection. The setting is the state of California (database of all hospitals in the state) and The University of California, San Francisco (UCSF; a tertiary care referral center). The study population is a consecutive sample of older (greater than or equal to 75 years) and younger (16 to 74 years) patients from California (January 1990 to December 1996; n = 3,113) and UCSF (January 1993 to November 2000; n = 218), who underwent radical pancreaticoduodenectomy, distal pancreatectomy, or total pancreatectomy for neoplasia. The main outcomes measures were length of stay, complications, mortality, discharge disposition, supplemental nutrition requirement, and readmissions.


RESULTS
Elderly patients had higher mortality rates than the young statewide (10% versus 7%, p = 0.006). Although the 3% mortality at UCSF was the same for both groups, older patients were more often admitted to the ICU (47% versus 20%, p = 0.003), treated for major cardiac events (13% versus 0.5%, p < 0.001), discharged with enteral tube feedings (48% versus 16%, p < 0.001), or malnourished on readmission (17% versus 2%, p < 0.005). Older patients were more frequently discharged to skilled nursing facilities (17% versus 1% at UCSF; 24% versus 7% in California; p < 0.001, both groups).


CONCLUSIONS
Older patients are more likely than younger patients to require an ICU stay, suffer a cardiac complication, and experience compromised nutritional and functional status after major pancreatic resection.
Lightner
Amy M
AM
Department of Surgery, University of California-San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143-0790, USA.
Glasgow
Robert E
RE
Jordan
Thomas H
TH
Krassner
Alexander D
AD
Way
Lawrence W
LW
Mulvihill
Sean J
SJ
Kirkwood
Kimberly S
KS
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004750:Enteral Nutrition; D006801:Humans; D008875:Middle Aged; D009752:Nutritional Status; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010359:Patient Readmission; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome