Impact of Age and Comorbidity on Perioperative Mortality after 250 Pancreatic Head Resections

Background: In line with the current demographic development, elderly patients make up an increasing proportion of surgical patients. It is still unclear under which conditions pancreatic surgery can be performed with low mortality in these patients.

Methods: From 2009 to 2014, 250 consecutive pancreatoduodenectomies (PDs) were performed in a non-university hospital. Perioperative data were documented prospectively. Based on median patient age (< 70 years vs. ≥ 70 years), a retrospective analysis of perioperative morbidity and mortality was performed. In addition, subgroup analyses were conducted.

Results: Older patients had a significantly higher frequency of cardiovascular comorbidities (p = 0.04), diabetes mellitus (p = 0.01), impaired renal function (p = 0.01) and a higher ASA classification (p < 0.01). Also, surgical procedures due to malignancy were significantly more common in this group (p < 0.01). Morbidity was equally high in both groups (< 70 years: 57 % vs. ≥ 70 years: 65 %; p = 0.02). Mortality was significantly higher in patients over 70 years of age (< 70 years: 1.4 % vs. ≥ 70 years: 9.1 %; p < 0.01). In a multivariate analysis, only liver cirrhosis (p < 0.01) and age (≥ 70 years; p = 0.04) were independent risk factors for postoperative mortality. However, it was also demonstrated that, under certain conditions, even much older patients (≥ 80 years; n = 34) may be subjected to surgery with a low mortality (3 %).

Conclusions: In elderly patients, PD is more frequently indicated in cases of malignancy. All in all, perioperative mortality in patients over 70 years of age is significantly elevated. Under certain conditions, however, even much older patients may safely undergo pancreatic surgery.