title: The Charlson age comorbidity index predicts early mortality after surgery for pancreatic cancer.
abstract: BACKGROUND
  Although operative resection represents the only hope for cure in pancreatic cancer, it is associated with significant morbidity and mortality. Furthermore, in some patients disease progression occurs very early postoperatively and no tangible benefit is seen from the operation. Identification of preoperative predictors of death within the first year of surgery could help in the counseling of patients diagnosed with pancreatic cancer.
  
  
  METHODS
  We studied retrospectively patients who underwent resection for pancreatic adenocarcinoma from 2002 to 2012. We calculated the age-adjusted Charlson Age Comorbidity Index (CACI) and used logistic regression models to determine predictors of mortality within 1 year of surgery. Kaplan-Meier curves and Cox proportional hazards models were developed to determine hazard ratios on survival.
  
  
  RESULTS
  Surgery with curative intent was performed in 497 patients; 136 (27%) died within the first year. A CACI score of >4 was predictive of increased duration of stay (P < .001), postoperative complications (P = .042), and mortality within 1 year of pancreatic resection (P < .001). A CACI score of ≥ 6 increased 3-fold the odds of death within the first year.
  
  
  CONCLUSIONS
  CACI is useful to predict outcome after pancreatectomy for pancreatic cancer. Patients with a high CACI score have a <50% likelihood of being alive 1 year postoperatively. This information should be used when considering the appropriateness of pancreatic resection in patients with multiple comorbidities.
authors.affiliation: Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Boston, MA; Chronic Diseases Research Centre, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dias-Santos
authors.affiliation: Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Boston, MA.
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Ferrone
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Boston, MA.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Boston, MA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Boston, MA. Electronic address: CFERNANDEZ@mgh.harvard.edu.
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-Del Castillo
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment