Evaluating the Impact of Preoperative Geriatric-Specific Variables and Modified Frailty Index on Postoperative Outcomes After Elective Pancreatic Surgery
Background Pursuing pancreatic resection in elderly patients is often complex and limited by concern for functional status and postoperative risk. This study examines the associations between two different preoperative functional status metrics with postoperative outcomes in the geriatric population...
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Published in | World journal of surgery Vol. 46; no. 11; pp. 2797 - 2805 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Cham
Springer International Publishing
01.11.2022
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Pursuing pancreatic resection in elderly patients is often complex and limited by concern for functional status and postoperative risk. This study examines the associations between two different preoperative functional status metrics with postoperative outcomes in the geriatric population.
Methods
Patients who participated in the ACS NSQIP Geriatric Surgery Research File pilot program (2014–2018) undergoing elective pancreatic operations were included. Two clinically meaningful functional status scores were calculated: the presence of one or more geriatric-specific variable (GSV) and a 5-factor modified frailty index (mFI-5). Multivariable logistic regression adjusting for ACS NSQIP-estimated risk was performed to evaluate associations between preoperative GSV, mFI-5 and 30-day outcome measures.
Results
A total of 1266 patients were included: 808 (64%) age 65–74, 302 (24%) age 75–80, and 156 (12%) age ≥ 81; 843 (67%) patients underwent pancreatoduodenectomy. Operations were performed for pancreatic adenocarcinoma in 712 (56%) patients. Older patients had greater likelihood of postoperative morbidity (35% vs 31% vs 47%, by age group,
p
= 0.004) and discharge to a facility (12% vs 23% vs 48%, by age group,
p
< 0.001). Adjusting for ACS NSQIP predicted risk, patients with a preoperative GSV were more likely to require reoperation and discharge to a facility (OR 1.81 [95% CI 1.03–3.16] and 3.95 [95% CI 2.91–5.38], respectively). The mFI-5 was not associated with postoperative outcomes (all
p
≥ 0.18).
Conclusion
The presence of a preoperative GSV is associated with reoperation and discharge to a skilled facility following elective pancreatic resection. Geriatric-specific variables should be considered in joint preoperative decision making to optimize care. |
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Bibliography: | Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self‐archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Copyright comment This paper was presented as part of Society for University Surgeons program at the 17th Annual Academic Surgical Congress, February 1–3, 2022, Orlando, FL. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0364-2313 1432-2323 |
DOI: | 10.1007/s00268-022-06710-x |