Surgical oncology outcomes in the aging US population.
As the population ages, an increasing number of older patients are undergoing major surgery. We examined the impact of advanced age on outcomes following major gastrointestinal cancer surgery in an era of improved surgical outcomes.



This was a population-based, retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. We evaluated patients undergoing major abdominal gastrointestinal cancer surgery from 2005-2012. Multivariable logistic regression was performed to determine the independent effect of advanced age on outcomes. Our primary outcome was 30-d mortality, and our secondary outcomes were 30-d major postoperative adverse events, discharge disposition, length of stay, reoperation, and readmission.



Elderly (≥65 y) patients were twice as likely to have multiple comorbidities as those <65 y but prevalence of comorbidities was similar across all older age groups. Mortality increased with age across all procedures (P < 0.05). The risk of advanced age on mortality was highest in hepatectomy (odds ratio = 5.17, 95% confidence interval = 2.19-12.20) and that for major postoperative adverse events was highest in proctectomy (odds ratio = 2.32, 95% confidence interval = 1.53-3.52). Patients were more likely to be discharged to an institutional care facility as age increased across all procedures (P < 0.01).



Despite being highly selected for surgery, elderly patients undergoing major gastrointestinal cancer surgery have substantially worse postoperative outcomes than younger patients (<65 y). The risk of age on postoperative outcomes was present across all operations but had its highest association with liver and rectal cancer resections.
Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York; Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York. Electronic address: hey9002@med.cornell.edu.
Heather L
HL
Yeo
Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York.
Paul R A
PR
O'Mahoney
Department of Geriatrics and Palliative Medicine, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York.
Mark
M
Lachs
Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York.
Fabrizio
F
Michelassi
Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York.
Jialin
J
Mao
Department of Surgery, University of California San Francisco Medical Center, San Francisco, California; Department of Medicine, University of California San Francisco Medical Center, San Francisco, California; Department of Health Policy, University of California San Francisco Medical Center, San Francisco, California.
Emily
E
Finlayson
Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York.
Jonathan S
JS
Abelson
Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York.
Art
A
Sedrakyan
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
80 and over; Aged; Gastrointestinal neoplasms; Operative; Postoperative complications; Surgical procedures