title: Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment.
abstract: BACKGROUND
  Older patients are increasingly faced with pancreatic surgery because of shifting demographics. The differential effects of aging on surgical outcomes remain vague, while the elderly patient is often neglected in clinical trials.
  
  
  METHODS
  Medical records of 370 patients who underwent pancreaticoduodenectomy were analyzed. Patients were then subdivided into 3 groups according to age and comorbidities.
  
  
  RESULTS
  Overall mortality was 5% and did not significantly differ between age-matched groups. Increasing age was linked to a higher prevalence of diabetes mellitus (p < 0.001) and preoperative cardiovascular comorbidities (p < 0.001). Independent risk factors for major complications were age over 70 years (p = 0.018; OR 2.3), elevated body mass index (p = 0.004; OR 0.2) and cardiovascular comorbidities (p = 0.022; OR = 2.6). Patients who were older (>70 years), obese and had cardiovascular disease had an increased risk of major complications when compared with the younger study population (p = 0.010).
  
  
  CONCLUSIONS
  Pancreatic surgery in elderly patients showed similar mortality rates as in younger patients. Nevertheless, a careful risk assessment is particularly important because older patients who are considered to be high risk suffer more frequently from major surgical complications compared with young patients that have similar risk profiles.
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Wiltberger
authors.forename: Babett
authors.initials: B
authors.lastname: Muhl
authors.forename: Christian
authors.initials: C
authors.lastname: Benzing
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Hau
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
authors.forename: Felix
authors.initials: F
authors.lastname: Krenzien
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D021441:Carcinoma, Pancreatic Ductal / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult