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SURGICAL OUTCOMES AND COSTS OF PANCREATICODUODENECTOMY IN OCTOGENARIANS
Yuan Fang1, Leyo Ruo2, Deepak Dath2, Michael Marcaccio2, Ved Tandan2, Pablo E. Serrano*2
1University of Virginia, Hamilton, Canada; 2Surgery, McMaster University, Hamilton, ON, Canada
Background
The risks of postoperative complications following pancreaticoduodenectomy is thought to be higher in octogenarians compared to younger patients. However, the costs of pancreaticoduodenectomy in this population are thought to be similar to younger patients despite a higher rate of complications. This study focuses on evaluating the postoperative outcomes and costs following pancreaticoduodenectomy in octogenarians compared to younger patients.
Methods
This is a retrospective database review of patients undergoing pancreaticoduodenectomy at a single institution from 2009-2014. Patient demographics, operative details and postoperative complications were obtained from patients’ charts. Hospitalization and emergency room costs up to 90 days following surgery were obtained from hospital administrative databases and were included in the analyses. Risk factors associated with postoperative complications were evaluated by univariable and multivariable analyses.
Results
There were 276 patients included and divided into two age groups: 253 younger patients (<80 years, median age=65) and 23 octogenarians (>=80 years, median age=82). Pancreatic cancer was the most common indication for surgery (58% vs. 65%). The mean ASA class was higher in the octogenarian group (3.2 vs. 3.4, P=0.026). The length of hospital stay was longer in this group also (9 vs. 11 days, P=0.042). The overall postoperative complication (47% vs. 74%, P=0.015) and the major complication rate (18% vs. 39%, P=0.016) were higher in the octogenarian group, mainly due to a higher rate of pneumonia (5% vs. 22%, P=0.011). The rehospitalization rate and the postoperative mortality were not statistically different between the two groups. In the multivariable analysis, factors associated with major complications were age >80 (OR=3.2, 95% confidence interval=2.27-4.13) and a diagnosis other than pancreatic cancer (OR=2.65, 95% confidence interval=2.02-3.27). There was a trend for a higher overall mean cost in the octogenarian group, $32,616 (SD=32,616) vs. $34,649 (SD=42,340) mainly driven by a higher cost of primary surgery, $28,053 (SD=23,241) vs. $33,271 (SD=42,559).
Conclusions
Pancreaticoduodenectomy in octogenarians is associated with a higher rate of overall and major postoperative complications, which lead to a longer length of hospital stay and higher costs for the healthcare system.
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