title: [Impact of Age and Comorbidity on Perioperative Mortality after 250 Pancreatic Head Resections].
abstract: BACKGROUND
  In line with the current demographic development, elderly patients make up an increasing proportion of surgical patients. It is still unclear under which conditions pancreatic surgery can be performed with low mortality in these patients.
  
  
  METHODS
  From 2009 to 2014, 250 consecutive pancreatoduodenectomies (PDs) were performed in a non-university hospital. Perioperative data were documented prospectively. Based on median patient age (< 70 years vs. ≥ 70 years), a retrospective analysis of perioperative morbidity and mortality was performed. In addition, subgroup analyses were conducted.
  
  
  RESULTS
  Older patients had a significantly higher frequency of cardiovascular comorbidities (p = 0.04), diabetes mellitus (p = 0.01), impaired renal function (p = 0.01) and a higher ASA classification (p < 0.01). Also, surgical procedures due to malignancy were significantly more common in this group (p < 0.01). Morbidity was equally high in both groups (< 70 years: 57 % vs. ≥ 70 years: 65 %; p = 0.02). Mortality was significantly higher in patients over 70 years of age (< 70 years: 1.4 % vs. ≥ 70 years: 9.1 %; p < 0.01). In a multivariate analysis, only liver cirrhosis (p < 0.01) and age (≥ 70 years; p = 0.04) were independent risk factors for postoperative mortality. However, it was also demonstrated that, under certain conditions, even much older patients (≥ 80 years; n = 34) may be subjected to surgery with a low mortality (3 %).
  
  
  CONCLUSIONS
  In elderly patients, PD is more frequently indicated in cases of malignancy. All in all, perioperative mortality in patients over 70 years of age is significantly elevated. Under certain conditions, however, even much older patients may safely undergo pancreatic surgery.
authors.affiliation: Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Riediger
authors.affiliation: Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
authors.forename: C M
authors.initials: CM
authors.lastname: Krueger
authors.affiliation: Klinik für Chirurgie, Universitätsklinikum Freiburg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Makowiec
authors.affiliation: Klinik für Chirurgie - Visceral- und Gefäßchirurgie, Humboldt-Klinikum, Berlin, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Adam
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D050500:Pancreatitis, Chronic / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult