Elderly patients had more severe postoperative complications after pancreatic resection: A retrospective analysis of 727 patients

Table 1 Demographic, comorbidity, operation type, and pathology data in patients grouped according to age

Variable	< 65 yr, n = 454	≥ 65 yr, n = 273	Total, n = 727	P value
Sex
Male	202	159	361
Female	252	114	366
Male:female ratio	0.8	1.4	1.0	0.0003
Mean BMI in kg/m2	23.1	23.4	23.2	0.351
Smoking				0.129
Never	323	180	503
Ever	130	93	223
Mean smoking amount. in packs/yr	50	53	51	0.127
Mean smoking time in yr	22.1	26.1	23.7	0.101
Alcohol				0.017
Never	367	200	567
Ever	87	73	160
Mean preoperative TBIL in μmol/L	31.4	42.8	36.3	0.134
Preoperative serum albumin in g/L	39.7	37.8	38.9	0.111
ASA category III + IV	89	77	166	0.007
Preoperative biliary drainage	51	49	100	0.011
Comorbidity
Patients with any comorbidity	147	171	318	< 0.001
Diabetes	89	73	162	0.025
Coronary artery disease	18	57	75	< 0.001
Hypertension	77	63	140	0.043
COPD	11	12	23	0.141
HBV	26	9	35	0.138
HCV	11	4	15	0.379
Previous history of cancer	3	6	9	0.070
Previous abdominal surgery	61	37	98	0.964
Family history of cancer	49	50	99	0.004
Operation type
Pancreaticoduodenectomy	232	153	385	0.196
Distal pancreatectomy	169	112	281	0.308
Middle-segment pancreatectomy	43	8	51	0.0008
Pathology data
Pancreatic duct adenocarcinoma	94	101	195	< 0.001
Others1	360	172	532

¹Distal bile duct adenocarcinoma, ampulla adenocarcinoma, gall bladder adenocarcinoma, duodenal adenocarcinoma, intraductal papillary mucinous neoplasm, neuroendocrine neoplasm, pancreatic metastasis, solid pseudopapillary tumor, benign neoplasm, pancreatitis. ASA: American Society of Anesthesiologists; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; HBV: Hepatitis B virus; HCV: Hepatitis C virus; TBIL: Total bilirubin.

Table 2 Postoperative complications in patients grouped according to age

Complication	< 65 yr, n = 454	≥ 65 yr, n = 273	Total, n = 727	P value
Patients with any complication	150 (33.0)	108 (39.6)	258 (35.5)	0.075
Patients with severe complication (grades IIIb-V)	41 (9.0)	46 (16.8)	87 (12.0)	0.002a
Pancreatic fistula	72 (15.9)	55 (20.1)	127 (17.5)	0.140
Delayed gastric emptying	45 (9.9)	35 (12.8)	80 (11.0)	0.225
Bile leak	15 (3.3)	14 (5.1)	29 (4.0)	0.224
Reoperation	12 (2.6)	11 (4.0)	23 (3.2)	0.301
Readmission	4 (0.9)	1 (0.4)	5 (0.7)	0.416
Gastrointestinal hemorrhage	9 (2.0)	13 (4.8)	22 (3.0)	0.034a
Wound infection	18 (4.0)	12 (4.4)	30 (4.1)	0.777
Cholangitis	6 (1.3)	5 (1.8)	11 (1.5)	0.585
Urinary tract infection	12 (2.6)	16 (5.9)	28 (3.9)	0.029a
Pneumonia	7 (1.5)	10 (3.7)	17 (2.3)	0.067
Intraabdominal abscess	13 (2.9)	7 (2.6)	20 (2.8)	0.811
Bacteremia	7 (1.5)	9 (3.3)	16 (2.2)	0.118
Central line infection	12 (2.6)	10 (3.7)	22 (3.0)	0.437
Pulmonary embolus	0 (0)	1 (0.4)	1 (0.1)	0.197
Deep venous thrombosis	1 (0.2)	3 (1.1)	4 (0.5)	0.121
Arrhythmia	10 (2.2)	11 (4.0)	21 (2.9)	0.154
Cerebrovascular accident	1 (0.2)	1 (0.4)	2 (0.3)	0.716
Mortality	4 (0.9)	15 (5.5)	19 (2.6)	< 0.001a

Data are presented as n (%).

^aStatistical significance.

Table 3 Association among operative difficulty, postoperative hospital stay and cost with age

Variable	< 65 yr, n = 454	≥ 65 yr, n = 273	Total, n = 727	P value
Mean operative time in min	239.8	247.5	243.1	0.330
Mean intraoperative blood loss in mL	461.0	479.1	468.0	0.650
Blood transfusion, n	169	129	298	0.008
Mean postoperative hospital stay in d	21.1	22.7	21.9	0.150
Mean cost in RMB	76411	73610	74717	0.790

Table 4 Univariate and multivariate Cox proportional hazards models for severe postoperative complications (grades IIIb-V)

Variable	Subgroup	Univariate	Multivariate
		P value	P value	HR (95%CI)
Medical risk factors
Age in yr	< 65 vs ≥ 65	0.002	0.010	1.63 (1.18-6.30)
BMI	< 24 kg/m2vs ≥ 24 kg/m2	0.012	0.041	1.20 (1.07-5.89)
ASA classification	I/II vs III/IV	0.038	0.271	-
Surgical risk factors
Pancreaticoduodenectomy	Yes vs No	< 0.001	0.017	4.86 (1.20-8.31)
Length of operation	< 241 min vs ≥ 241 min (median)	0.004	0.012	2.97 (1.04-6.14)

ASA: American Society of Anesthesiologists; BMI: Body mass index; CI: Confidence interval; HR: Hazard ratio.