Hospital-level resource use by the oldest-old for pancreaticoduodenectomy at high-volume hospitals

Abstract

Introduction Due to limited data on hospital resources consumed in caring for the oldest-old, we examined the use of pancreaticoduodenectomy (PD)-relevant hospital resources in patients of increasing age treated in high-volume-hospitals (HVH) participating in the University HealthSystem Consortium (UHC). Methods Perioperative outcomes, resource use and direct costs were compared across increasing age groups in 12,766 PDs (< 70 years n=8,564, 70-79 years n=3,302, ≥ 80 years n=900) performed in 79 HVHs between 2010 and 2014. Linear regression models with and without covariate adjustments were used to assess the impact of older age. Results The oldest-old experienced fewer readmissions and had equivalent ICU-use and mortality rates compared to both younger cohorts. However, those ≥ 80-years experienced more complications, blood transfusions, greater TPN use, longer LOS and higher direct hospital costs compared to those < 70 years (Table 2). No differences were found between patients ≥ 80-years and those 70–79 years with respect to the administration of blood products, TPN or the direct cost of PD. Conclusion Our findings suggest the ability to deliver quality pancreatic surgical care to an aging population without strong associations to increased resource utilization. As the number of octogenarians undergoing PD continues to grow, the impact of this technically complex procedure on other important cancer care metrics including patient reported outcomes and quality of life requires further assessment.

The outcomes of pancreaticoduodenectomy in patients aged 80 or older: a systematic review and meta-analysis

“…1,2 It is also a valid treatment option in selected patients with benign tumours and non-cancerous conditions such as chronic pancreatitis. 3 The overall morbidity and mortality associated with PD ranges between 45 and 52% [4][5][6] and 0-5% [7][8][9][10] respectively.…”

“…12 The 5-year actuarial survival rate of pancreatic cancer following surgical resection ranges from 12 to 24% even in large volume centres. 14,15 Although there are studies from several countries comparing the outcomes of elderly patients treated by PD with younger groups, 10,12,16 definitive conclusions regarding the relative risk of age in relation to mortality and specific complications, incorporating data from more recent studies are lacking. 17 This study aims to provide a comprehensive update on the outcomes patients aged over 80 years undergoing PD compared to younger age group and quantitate possible differences in overall mortality and morbidity, including comparison of specific complications.…”

Age 80 years and over is not associated with increased morbidity and mortality following pancreaticoduodenectomy

“…It is estimated that the 5‐year survival rate after resection of pancreatic cancer is only 12–24% . There are several recent studies from the United States, Germany and Italy that have retrospectively analysed data on outcomes of elderly patients treated by PD compared with younger subgroups generally suggesting greater post‐operative complications and mortality in the older group. As far as we are aware, there have been no Australian series that have reported on such an outcome that will allow comparisons with other reported literature.…”

Ampullary adenocarcinoma: Defining predictors of survival and the impact of adjuvant therapy following surgical resection for stage I disease

“…That older age is negatively associated with OS in this analysis may in part, be related to additional comorbidities and shorter overall life expectancy in this age group as well as the extent of surgery required. Although some series have reported higher rates of surgical morbidity in elderly patients undergoing pancreatoduodenectomy, these reports have generally referred to octogenarian or more elderly patients . We submit that treatment for AAC not be based on any specific age, but rather an overall assessment of the individual patients' performance status, social support, and personal decisions based on appropriate information and education regarding the risks and benefits of therapy.…”

“…Although some series have reported higher rates of surgical morbidity in elderly patients undergoing pancreatoduodenectomy, these reports have generally referred to octogenarian or more elderly patients. [11][12][13][14][15] We submit that treatment for AAC not be based on any specific age, but rather an overall assessment of the individual patients' performance status, social support, and personal decisions based on appropriate information and education regarding the risks and benefits of therapy. and potentially under treatment for these patients.…”