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Objectives:

The percentage of octogenarians in the population is increasing and these patients are now more commonly seen in surgical practice. Colonic pathology is a major disease entity for which surgical therapy is sought by this age group. Octogenarians are more susceptible to complications and mortality after colectomy given their high incidence of comorbid factors and decreased physiologic reserve. There have been conflicting reports in the literature regarding the outcomes of this population with respect to laparoscopic colectomy. We sought to evaluate this using a national database sample.

Methods:

Using the ACS-NSQIP database, we identified all elective laparoscopic colectomies performed between 2007 and 2009 in patients ≥ 80 years of age. Preoperative co-morbidities, operative time, length of hospitalization and perioperative mortality and morbidity were compared between the two groups using chi-square and independent t-test as appropriate. A multivariate logistic regression analysis was used to analyze potential factors contributing to post-operative morbidity and mortality.

Results:

We identified 16,536 patients, of which 2,155 patients (13%) were ≥ 80 years and 14,381 patients (87%) were < 80 years old. Elective laparoscopic colectomy of any type with primary anastomosis was accomplished in each case. Independent predictors associated with a significantly increased rate of mortality were male gender (AOR 2.12), age above 80 years (AOR 2.92), dyspnea on exertion and rest (AOR 1.75 and 5.85 respectively), partially and completely dependent functional status (AOR 3.4 and 3 respectively), COPD (AOR 2.08), HTN (AOR 2.68), previous cardiac surgery (AOR 2.07), >10% weight loss (AOR 2.3), ASA III/IV (AOR 2.9), ascites (AOR 23.3). In the immediate postoperative period the group of patients ≥ 80 years had a higher incidence of PE (1.1% vs. 0.3%), failure to wean and subsequent reintubation (2.2% vs. 0.9% and 2.9% vs. 1.1% respectively), cardiac arrest (0.6% vs. 0.2%) and septic shock (2.4% vs. 0.8%). There was no difference in terms of wound-related complications in both groups. Operative time was found to be shorter for patients ≥ 80 years (141 vs. 161 min), but reoperation rate within 30 days was higher (AOR 3). The rate of major complications and death were also higher (AOR 1.73 and 6 respectively).

Conclusion:

Despite the potential benefits derived from a laparoscopic approach, octogenarians had a higher morbidity and mortality rate. Independent risk factors which increased the probability of complications post-operatively were defined. These must be weighed carefully in the risk-benefit analysis of an octogenarian about to undergo an elective colectomy. Interestingly, the presence of ascites was the strongest predictor of mortality in this analysis.