title: Postoperative outcomes following pancreaticoduodenectomy: how should age affect clinical practice?
abstract: BACKGROUND
  Pancreaticoduodenectomy is an increasingly common procedure performed for both benign and malignant disease. There are conflicting data regarding the safety of pancreatic resection in older patients. Potentially modifiable perioperative risk factors to improve outcomes in older patients have yet to be determined.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for 2008 to 2009 was used for this retrospective analysis. Patients undergoing pancreaticoduodenectomy were identified and divided into those above and below the age of 65. Preoperative risk factors and postoperative morbidity and mortality were evaluated.
  
  
  RESULTS
  Among 2,045 patients included in this analysis, 994 patients were >65 years (48.6%) while 1,051 were (less than or equal to) 65 years (51.4%). Thirty-day mortality was higher in the older age group compared to the younger age group 3.6% vs. 1.9% respectively, P = 0.017, odds ratio 1.94. Older patients had a higher incidence of unplanned intubation, ventilator support >48 h and septic shock compared with younger patients. On multivariate logistic regression, after adjusting for other 30-day postoperative occurrences (significant at the P <0.1 level) only septic shock was independently associated with a higher odds of mortality, unplanned intubation, and ventilator support >48 h in older patients compared with younger patients.
  
  
  CONCLUSIONS
  This report from a population-based database is the first to highlight postoperative sepsis as an independent risk factor for mortality and morbidity in older patients undergoing pancreatic resection. Careful perioperative management addressing this issue is essential for patients over the age of 65.
authors.affiliation: Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Cairo Street, Beirut 1107 2020, Lebanon. wfaraj@hotmail.com
authors.forename: Walid
authors.initials: W
authors.lastname: Faraj
authors.forename: Raafat
authors.initials: R
authors.lastname: Alameddine
authors.forename: Deborah
authors.initials: D
authors.lastname: Mukherji
authors.forename: Khaled
authors.initials: K
authors.lastname: Musallam
authors.forename: Ali
authors.initials: A
authors.lastname: Haydar
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eloubiedi
authors.forename: Ali
authors.initials: A
authors.lastname: Shamseddine
authors.forename: Ali
authors.initials: A
authors.lastname: Halal
authors.forename: Ghassan K
authors.initials: GK
authors.lastname: Abou-Alfa
authors.forename: Eileen M
authors.initials: EM
authors.lastname: O'Reilly
authors.forename: Faek
authors.initials: F
authors.lastname: Jamali
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khalife
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult