title: Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study.
abstract: OBJECTIVE
  To identify the mortality risk factors of elderly patients (≥65 years old) during major digestive surgery, as defined according to the complexity of the operation.
  
  
  BACKGROUND
  In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes.
  
  
  METHODS
  We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality.
  
  
  RESULTS
  In the entire cohort, postoperative mortality increased significantly among patients aged 65-74 years, and an age ≥65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36-3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age ≥85 years (OR, 2.62; 95% CI, 1.08-6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67-6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02-3.17; P = 0.041), white cell count > 10,000/mm³ (OR, 1.90; 95% CI, 1.08-3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77-54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99-8.19; P < 0.001).
  
  
  CONCLUSIONS
  Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients.
authors.affiliation: Digestive Surgery and Liver Transplantation Unit, University Hospital Pitie-Salpêtrière, 46-83, Boulevard de l'Hôpital, Paris, France. jjduron@orange.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Duron
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Duron
authors.forename: Thimothée
authors.initials: T
authors.lastname: Dugue
authors.forename: José
authors.initials: J
authors.lastname: Pujol
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Hay
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004066:Digestive System Diseases / Q000401:mortality* / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005602:France; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult