title: Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review.
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.
authors.affiliation: Northside Medical Center, Department of General Surgery, Youngstown, OH 44501, USA. Prashantsukharamwala@yahoo.com
authors.forename: Prashant
authors.initials: P
authors.lastname: Sukharamwala
authors.forename: Sukharamwala
authors.initials: S
authors.lastname: Prashant
authors.forename: Jonathan
authors.initials: J
authors.lastname: Thoens
authors.forename: Thoens
authors.initials: T
authors.lastname: Jonathan
authors.forename: Mauricio
authors.initials: M
authors.lastname: Szuchmacher
authors.forename: Szuchmacher
authors.initials: S
authors.lastname: Mauricio
authors.forename: James
authors.initials: J
authors.lastname: Smith
authors.forename: Smith
authors.initials: S
authors.lastname: James
authors.forename: Peter
authors.initials: P
authors.lastname: DeVito
authors.forename: DeVito
authors.initials: D
authors.lastname: Peter
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality*; D011014:Pneumonia / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome