The effect of age on short-term outcomes after pancreatic resection: a population-based study.
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.
Riall
Taylor S
TS
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542, USA. tsriall@utmb.edu
Reddy
Deepthi M
DM
Nealon
William H
WH
Goodwin
James S
JS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality*; D010182:Pancreatic Diseases / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
Health Serv Res. 1992 Dec;27(5):587-606; discussion 607-12
1464535
J Gastrointest Surg. 1998 May-Jun;2(3):207-16
9841976
Surg Clin North Am. 1994 Apr;74(2):317-44
8165471
Am Surg. 2001 Mar;67(3):270-5; discussion 275-6
11270888
Natl Vital Stat Rep. 2002 Mar;50(6):1-39
25077730
Ann Surg. 1995 Oct;222(4):426-34; discussion 434-7
7574924
Hepatogastroenterology. 1999 Jul-Aug;46(28):2589-98
10522047
Med Care. 2006 Aug;44(8):745-53
16862036
J Gastrointest Surg. 2006 Mar;10(3):347-56
16504879
Surgery. 2004 Jun;135(6):569-75
15179361
Eur J Surg. 1999 Mar;165(3):230-5
10231656
Am J Surg. 1993 Jan;165(1):68-72; discussion 72-3
8380315
Ann Surg. 1998 Jun;227(6):821-31
9637545
J Gastrointest Surg. 2006 Nov;10(9):1199-210; discussion 1210-1
17114007
J Gastrointest Surg. 2006 Jun;10(6):813-22
16769537
Arch Surg. 2006 Feb;141(2):137-42
16490889
Arch Surg. 2001 Apr;136(4):391-8
11296108
Ann Surg. 2003 Aug;238(2):170-7
12894008
World J Surg. 2000 Mar;24(3):353-8
10658072
Langenbecks Arch Chir Suppl Kongressbd. 1996;113:492-4
9101910