Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery

Qiang Lu,1–3 Jian-Wen Lu,1–3 Zheng Wu,1–3 Xue-Min Liu,1–3 Jian-Hui Li,2–4 Jian Dong,1–3 Guo-Zhi Yin,1 Yi Lv,1–3 Xu-Feng Zhang1–3 1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jia...

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Autores principales:	Lu Q, Lu JW, Wu Z, Liu XM, Li JH, Dong J, Yin GZ, Lv Y, Zhang XF
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	morbidity elderly hepatectomy pancreaticoduodenectomy Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/a9965655c338488fb6eb571ae8590ee6
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spelling	oai:doaj.org-article:a9965655c338488fb6eb571ae8590ee62021-12-02T06:01:06ZPerioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery1178-1998https://doaj.org/article/a9965655c338488fb6eb571ae8590ee62018-01-01T00:00:00Zhttps://www.dovepress.com/perioperative-outcome-of-elderly-versus-younger-patients-undergoing-ma-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Qiang Lu,1–3 Jian-Wen Lu,1–3 Zheng Wu,1–3 Xue-Min Liu,1–3 Jian-Hui Li,2–4 Jian Dong,1–3 Guo-Zhi Yin,1 Yi Lv,1–3 Xu-Feng Zhang1–3 1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 2Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 3Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi’an, Shaanxi, China; 4Department of Surgical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China Objective: The aim of this study was to determine the safety of elderly cancer patients (≥70 years) undergoing hepatic resection (HR) or pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years).Methods: A total of 1,012 consecutive patients undergoing HR or PD were included. The incidence and severity of morbidity were documented within 30 days postoperatively and compared between elderly and younger groups. Risk factors associated with postoperative morbidity were investigated by multivariate logistic regression analysis.Results: Elderly patients (n=111, 11.0%) had more comorbidities and worse preoperative general condition and liver function versus younger patients (n=901, 89.0%), and thus were more likely to develop infectious (eg, systemic sepsis and urinary tract infection, both p<0.01) and technical-associated complications (intraperitoneal bleeding and biliary/pancreatic fistula, p=0.029 and p=0.074, respectively). However, the incidence and severity of complications were comparable between elderly and younger patients in the whole cohort, and also in HR and PD surgery groups separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002), rather than age, were independently associated with postoperative morbidity. Hepatitis (OR 2.9, p=0.001), preoperative hemoglobin (OR 1.6, p=0.036), and pancreatic versus hepatic surgery (OR 2.3, p=0.005) were independently associated with postoperative infectious. For elderly patients only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p=0.033) and intraoperative blood transfusion (OR 3.2, p=0.030) were independently associated with postoperative morbidity.Conclusion: HR and PD can be safely performed in selected elderly patients versus younger patients. Elderly patients with ASA score III or above should be cautiously selected for major surgeries. Keywords: morbidity, elderly, hepatectomy, pancreaticoduodenectomyLu QLu JWWu ZLiu XMLi JHDong JYin GZLv YZhang XFDove Medical PressarticlemorbidityelderlyhepatectomypancreaticoduodenectomyGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 133-141 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	morbidity elderly hepatectomy pancreaticoduodenectomy Geriatrics RC952-954.6
spellingShingle	morbidity elderly hepatectomy pancreaticoduodenectomy Geriatrics RC952-954.6 Lu Q Lu JW Wu Z Liu XM Li JH Dong J Yin GZ Lv Y Zhang XF Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
description	Qiang Lu,1–3 Jian-Wen Lu,1–3 Zheng Wu,1–3 Xue-Min Liu,1–3 Jian-Hui Li,2–4 Jian Dong,1–3 Guo-Zhi Yin,1 Yi Lv,1–3 Xu-Feng Zhang1–3 1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 2Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 3Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi’an, Shaanxi, China; 4Department of Surgical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China Objective: The aim of this study was to determine the safety of elderly cancer patients (≥70 years) undergoing hepatic resection (HR) or pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years).Methods: A total of 1,012 consecutive patients undergoing HR or PD were included. The incidence and severity of morbidity were documented within 30 days postoperatively and compared between elderly and younger groups. Risk factors associated with postoperative morbidity were investigated by multivariate logistic regression analysis.Results: Elderly patients (n=111, 11.0%) had more comorbidities and worse preoperative general condition and liver function versus younger patients (n=901, 89.0%), and thus were more likely to develop infectious (eg, systemic sepsis and urinary tract infection, both p<0.01) and technical-associated complications (intraperitoneal bleeding and biliary/pancreatic fistula, p=0.029 and p=0.074, respectively). However, the incidence and severity of complications were comparable between elderly and younger patients in the whole cohort, and also in HR and PD surgery groups separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002), rather than age, were independently associated with postoperative morbidity. Hepatitis (OR 2.9, p=0.001), preoperative hemoglobin (OR 1.6, p=0.036), and pancreatic versus hepatic surgery (OR 2.3, p=0.005) were independently associated with postoperative infectious. For elderly patients only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p=0.033) and intraoperative blood transfusion (OR 3.2, p=0.030) were independently associated with postoperative morbidity.Conclusion: HR and PD can be safely performed in selected elderly patients versus younger patients. Elderly patients with ASA score III or above should be cautiously selected for major surgeries. Keywords: morbidity, elderly, hepatectomy, pancreaticoduodenectomy
format	article
author	Lu Q Lu JW Wu Z Liu XM Li JH Dong J Yin GZ Lv Y Zhang XF
author_facet	Lu Q Lu JW Wu Z Liu XM Li JH Dong J Yin GZ Lv Y Zhang XF
author_sort	Lu Q
title	Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
title_short	Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
title_full	Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
title_fullStr	Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
title_full_unstemmed	Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
title_sort	perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/a9965655c338488fb6eb571ae8590ee6
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Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery

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