737 Background: Octogenarians increasingly undergo curative GI cancer surgery, yet most risk tools apply a uniform “age penalty” across procedures. Whether age ≥80 confers similar operative mortality across resections is unclear. We examined if the mortality impact of advanced age differs between pancreatic resection and gastrectomy. Methods: We used a nationally representative U. S. inpatient dataset (2020–2022) to identify adults with pancreatic or gastric cancer who underwent the corresponding resection. The primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS), and hospital charges. Multivariable models adjusted for sex, hospital teaching status, and year. An age (≥80 vs <80) × operation interaction tested whether the age effect varied by procedure. A sensitivity analysis excluded records with metastatic disease codes. Results: We identified 15, 821 discharges (weighted ≈79, 095), including 9, 924 pancreatic resections and 5, 897 gastrectomies; 16. 1% were aged ≥80 years. In pooled models, adjusted in-hospital mortality was 3. 54% for patients ≥80 versus 2. 50% for those <80 (absolute difference +1. 04 percentage points; aOR 1. 43; p=0. 003). The age effect differed by procedure (interaction p=0. 024). For pancreatic resection, mortality was 3. 34% in patients ≥80 versus 1. 77% in those <80 (difference +1. 56 points; aOR 1. 91; 95% CI 1. 36–2. 68). For gastrectomy, mortality was 4. 09% in patients ≥80 versus 3. 74% in those <80 (difference +0. 35 points; aOR 1. 10; 95% CI 0. 78–1. 54), indicating no significant age-related increase. Length of stay was similar by age (8. 41 vs 8. 75 days; p=0. 06), while hospital charges were lower among patients ≥80 (133k vs 154k; p<0. 001). Conclusions: In contemporary U. S. practice, the excess operative mortality associated with age ≥80 is concentrated in pancreatic resections and is not significant for gastrectomy after adjustment. Preoperative counseling and risk stratification for very elderly patients should be procedure-specific rather than applying a uniform “age penalty, ” with particular caution for octogenarians considered for pancreatic resection. In-hospital mortality by age (≥80 vs <80) for curative GI cancer resections, U. S. inpatient 2020–2022. In-hospital mortality (%) ≥80 <80 Absolute difference (pp) Adjusted OR (95% CI) Pooled 3. 54 2. 50 +1. 04 1. 43 (—) Pancreatic resection 3. 34 1. 77 +1. 56 1. 91 (1. 36–2. 68) Gastrectomy 4. 09 3. 74 +0. 35 1. 10 (0. 78–1. 54) Mortality models adjusted for sex, hospital teaching status, and year. Pooled mortality aOR p=0. 003; age×procedure interaction p=0. 024.
Dirican et al. (Sat,) studied this question.