PANCREATICODUODENECTOMY IN THE OLDEST OF OLD: RESULTS BEYOND OPERATIVE
MORTALITY
Russell C. Langan, Weisheng Mao, Katherine Harris, Will Chapman, Charles Fehring, Peter R. Bucciarelli, Kesha
Oza, Patrick G. Jackson, Thomas Fishbein, Reena Jha, Nadim Haddad, Firas Al-Kawas, John Carroll, Jane Hanna,
Ann Parker, Waddah B. Al-Refaie, Lynt B. Johnson
Department of Surgery, Radiology and Gastroenterology, Georgetown University Hospital, Washington, DC
Introduction:
The projected expansion of the elderly population may have significant implications on providers, hospital service
lines and payers. Yet, there remains a paucity of data on the effect of the oldest old (≥ 80 years) on postpancreaticoduodenectomy (PD) outcomes beyond traditional operative mortality. We sought to assess potential
differences in the index surgical hospitalization for patients over 80 years as compared to younger cohorts.
Methods:
We identified 99 patients who underwent PD between 2005 and 2013. Perioperative outcomes were compared
across increasing age groups (I:≤ 70, II:71 – 79, III:≥ 80 years).
Results:
Median age was 66 years in cohort I, 74 years in the cohort II and 83 years in cohort III. Surgery was performed for
malignancy in 75% of cohort I, 77% of cohort II and 90% of cohort III. Median tumor size, stage and estimated
blood loss were equivalent across cohorts. There was no difference in the rate of pancreatic fistula, overall
postoperative complications or 60-day readmission between cohorts. Length of stay (LOS) was significantly longer
in cohort III as compared to cohort I (14.1 vs. 8.5 days; p = 0.0042) and trended toward significance in the cohort II
vs. cohort I (13.7 vs. 8.5 days; p = 0.08). LOS was equivalent between the cohort II and cohort III. Increasing age
was also significantly associated with discharge to a skilled facility (I: 6%, II: 13%, III: 27%; p = 0.02).
Conclusions:
Dogma states the oldest old will place significant strains on the existing healthcare system. However, we found
perioperative outcomes and adverse events comparable between all age groups and no difference in LOS between
septuagenarians and octogenarians. These results have future research and policy implications to overcome some of
the challenges of this growing cohort of the US population. Larger studies should be performed on larger patient
populations.