title: Hospital-level resource use by the oldest-old for pancreaticoduodenectomy at high-volume hospitals.
abstract: BACKGROUND
  Owing to limited data on hospital resources consumed in caring for the oldest-old, we examined the use of pancreaticoduodenectomy (PD)-relevant hospital resources in patients of increasing age treated in high-volume hospitals participating in the University HealthSystem Consortium.
  
  
  METHODS
  Perioperative outcomes, resource use, and direct costs were compared across increasing age groups in 12,766 PDs (<70 years, n = 8,564; 70-79 years, n = 3,302; ≥80 years, n = 900) performed in 79 high-volume hospitals between 2010 and 2014. Linear regression models with and without covariate adjustments were used to assess the impact of older age.
  
  
  RESULTS
  The oldest-old experienced fewer readmissions and had equivalent intensive care unit use and mortality rates compared with both younger cohorts. However, those ≥80 years experienced more complications, blood transfusions, greater total parenteral nutrition (TPN) use, longer duration of stay, and higher direct hospital costs compared with those <70 years No differences were found between patients ≥80 years and those 70-79 years with respect to the administration of blood products, TPN, or the direct cost of PD.
  
  
  CONCLUSIONS
  Our findings suggest the ability to deliver quality pancreatic surgical care to an aging population without strong associations to increased resource utilization. As the number of octogenarians undergoing PD continues to grow, the impact of this technically complex procedure on other important cancer care metrics, including patient-reported outcomes and quality of life, requires further assessment.
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC.
authors.forename: Chaoyi
authors.initials: C
authors.lastname: Zheng
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC.
authors.forename: Katherine
authors.initials: K
authors.lastname: Harris
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC.
authors.forename: Richard
authors.initials: R
authors.lastname: Verstraete
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC.
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC. Electronic address: JOHNSOL3@gunet.georgetown.edu.
authors.forename: Lynt B
authors.initials: LB
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017721:Hospital Costs / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000191:economics*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D014481:United States