title: Severe nutritional risk predicts decreased long-term survival in geriatric patients undergoing pancreaticoduodenectomy for benign disease.
abstract: BACKGROUND
  Weight loss and malnutrition are poorly tolerated by geriatric patients, and pancreaticoduodenectomy (PD) can result in chronic malabsorption and weight loss. We sought to determine how preoperative severe nutritional risk (SNR), as defined by the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society Best Practice Guidelines, affects long-term survival after PD for benign disease among geriatric and nongeriatric patients.
  
  
  METHODS
  All patients undergoing PD for nonmalignant conditions at a single center between 1995 and 2013 were followed for survival, excluding patients who died within 90 days of surgery. Survival of geriatric (age ≥65 years) and nongeriatric (age <65 years) patients with and without SNR was compared using Kaplan Meier methods. Cox regression was performed.
  
  
  RESULTS
  There were 320 patients who underwent PD for benign disease. Over the course of the study, the proportion of geriatric patients undergoing PD for benign conditions increased from 25% to 46%. In addition to being older, geriatric patients undergoing PD for benign disease were significantly more likely to have coronary artery disease (CAD) and hypertension. Geriatric patients with preoperative SNR had significantly decreased long-term survival after PD for benign disease (p < 0.001), with roughly 1 in 3 patients dead at 5 years compared with 1 in 14 patients without SNR. Survival was not significantly different among nongeriatric patients with and without SNR. In geriatric patients, age, CAD, and SNR were significantly associated with decreased survival on both univariate and multivariate analysis.
  
  
  CONCLUSIONS
  Severe nutritional risk can be a useful predictor of long-term survival in geriatric patients undergoing PD, and could improve patient risk stratification preoperatively. Nonoperative management should be strongly considered in geriatric patients with SNR, when malignancy is not suspected.
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO.
authors.forename: Dominic E
authors.initials: DE
authors.lastname: Sanford
authors.affiliation: Division of Geriatrics, Department of Medicine, Saint Louis University School of Medicine, Saint Louis, MO.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Sanford
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.affiliation: Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO. Electronic address: linehand@wudosis.wustl.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000150:complications*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D010195:Pancreatitis / Q000601:surgery; D012307:Risk Factors