Key result
The presence of a preoperative geriatric-specific variable was associated with increased odds of reoperation (OR 1.81; 95% CI 1.03-3.16) and discharge to a facility (OR 3.95; 95% CI 2.91-5.38).
Why the study?
Pancreatic resection in elderly patients is often complex and limited by concerns regarding functional status and postoperative risk.
Does the presence of preoperative geriatric-specific variables or modified frailty index predict adverse 30-day postoperative outcomes in elderly patients undergoing elective pancreatic surgery?
Cohort (n=1,266)
Yes
Does the presence of preoperative geriatric-specific variables or modified frailty index predict adverse 30-day postoperative outcomes in elderly patients undergoing elective pancreatic surgery?
Odds Ratio: 1.81 (95% CI 1.03–3.16)
In elderly patients undergoing elective pancreatic surgery, the presence of preoperative geriatric-specific variables, but not a modified frailty index, is associated with increased risk of reoperation and discharge to a skilled facility.
May aid risk stratification for elderly pancreatic surgery patients; leaves open prospective validation of geriatric variables.
BACKGROUND: Pursuing pancreatic resection in elderly patients is often complex and limited by concern for functional status and postoperative risk. This study examines the associations between two different preoperative functional status metrics with postoperative outcomes in the geriatric population. METHODS: Patients who participated in the ACS NSQIP Geriatric Surgery Research File pilot program (2014-2018) undergoing elective pancreatic operations were included. Two clinically meaningful functional status scores were calculated: the presence of one or more geriatric-specific variable (GSV) and a 5-factor modified frailty index (mFI-5). Multivariable logistic regression adjusting for ACS NSQIP-estimated risk was performed to evaluate associations between preoperative GSV, mFI-5 and 30-day outcome measures. RESULTS: A total of 1266 patients were included: 808 (64%) age 65-74, 302 (24%) age 75-80, and 156 (12%) age ≥ 81; 843 (67%) patients underwent pancreatoduodenectomy. Operations were performed for pancreatic adenocarcinoma in 712 (56%) patients. Older patients had greater likelihood of postoperative morbidity (35% vs 31% vs 47%, by age group, p = 0.004) and discharge to a facility (12% vs 23% vs 48%, by age group, p < 0.001). Adjusting for ACS NSQIP predicted risk, patients with a preoperative GSV were more likely to require reoperation and discharge to a facility (OR 1.81 [95% CI 1.03-3.16] and 3.95 [95% CI 2.91-5.38], respectively). The mFI-5 was not associated with postoperative outcomes (all p ≥ 0.18). CONCLUSION: The presence of a preoperative GSV is associated with reoperation and discharge to a skilled facility following elective pancreatic resection. Geriatric-specific variables should be considered in joint preoperative decision making to optimize care.
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Cramer et al. (2022) conducted a cohort in Elective pancreatic operations (n=1,266). Preoperative geriatric-specific variable (GSV) vs. Absence of GSV was evaluated on Reoperation (OR 1.81, 95% CI 1.03-3.16). The presence of a preoperative geriatric-specific variable was associated with increased odds of reoperation (OR 1.81; 95% CI 1.03-3.16) and discharge to a facility (OR 3.95; 95% CI 2.91-5.38).
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