Heather L Yeo1, Paul R A O'Mahoney2, Mark Lachs3, Fabrizio Michelassi2, Jialin Mao4, Emily Finlayson5, Jonathan S Abelson2, Art Sedrakyan4. 1. 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. 2. Department of Surgery, NewYork Presbyterian-Weill Cornell Medical College, New York, New York. 3. Department of Geriatrics and Palliative Medicine, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York. 4. Department of Healthcare Policy and Research, NewYork-Presbyterian-Weill Cornell Medical College, New York, New York. 5. 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.
Abstract
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Christine E Haugen; Elizabeth A King; Sunjae Bae; Mary Grace Bowring; Courtenay M Holscher; Jacqueline Garonzik-Wang; Mara McAdams-DeMarco; Dorry L Segev Journal: Am J Nephrol Date: 2018-09-18 Impact factor: 3.754
Authors: Rebecca A Aslakson; Sarina R Isenberg; Norah L Crossnohere; Alison M Conca-Cheng; Ting Yang; Matthew Weiss; Angelo E Volandes; John F P Bridges; Debra L Roter Journal: BMJ Open Date: 2017-06-06 Impact factor: 2.692
Authors: Iftekhar Kalsekar; Chia-Wen Hsiao; Hang Cheng; Sashi Yadalam; Brian Po-Han Chen; Laura Goldstein; Andrew Yoo Journal: Health Econ Rev Date: 2017-06-02