SSAT - Whipples in Octogenarians: Patient Selection Trumps Ageism

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Whipples in Octogenarians: Patient Selection Trumps Ageism
Audrey Ertel^*, Jeffrey M. Sutton, Koffi Wima, Richard S. Hoehn, Syed Ahmad, Jeffrey Sussman, Shimul a. Shah, Daniel E. Abbott

General Surgery, University of Cincinnati, Cincinnati, OH

Objectives: The average age at diagnosis of pancreatic cancer is 72 years and resection is the only potentially curative intervention. Debate continues regarding the safety of pancreaticoduodenectomy (PD) in aging patients, particularly those > 80 years old. We hypothesized that PD in selected patients 80 years or older was associated with an acceptable outcomes profile.
Methods: The University HealthSystems Consortium database was queried for all pancreaticoduodenectomies between 2009-2013 (n=16,983). We utilized univariate, multivariate, and 1:1 propensity score matching (comparing patients age > 80 to those age 70-79) analyses to determine the impact of increasing age on post-operative outcomes.
Results: 1370 patients (8%) > 80 years of age underwent PD in this cohort. There was an even distribution between genders, though elderly patients were more often white (83.6%, p=0.001). Center volume differed across age groups, with patients > 80 years more likely to receive care at highest volume centers vs. lowest volume centers (28.8 vs. 21.3%, p=0.001). Univariate analysis showed small increases in mortality (4.0 vs. 2.3%, p<0.001), length of stay (10 vs. 9, p<0.001), and cost (\,839 vs. \,485, p<0.001) between patients > 80 and those aged 70-79. Multivariate analysis confirmed increase in mortality (OR 1.90, 95% CI [1.36-2.67], p<0.002), length of stay (OR 1.09, [1.04-1.13], p<0.001), and cost (OR 1.08, [1.03-1.14], p<0.001). After propensity scoring, the effects of age on mortality (p= 0.089) and cost (p=0.089) were no longer significant while length of stay (p<0.001) and discharge to a rehabilitation facility (p<0.001) remained different across the stated age groups.
Conclusions: For appropriately selected patients, these data show that PD in the elderly (> 80) is safe and associated with a minimal increase in perioperative and post-discharge resource utilization. Age > 80 should not be a contraindication to PD this is important to realize as both the elderly population and the incidence of pancreatic cancer continue to grow.

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