Division of Surgical Oncology, Department of Surgery, University of Virginia, PO Box 800709, Charlottesville, VA, 22908-0709, USA.
Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
World J Surg. 2022 Nov;46(11):2797-2805. doi: 10.1007/s00268-022-06710-x. Epub 2022 Sep 8.
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.
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.
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).
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.
在老年患者中进行胰腺切除术往往较为复杂，并且受到对功能状态和术后风险的担忧的限制。本研究探讨了两种不同的术前功能状态指标与老年人群术后结果之间的关联。
纳入参与 ACS NSQIP 老年手术研究文件试点计划（2014-2018 年）并接受择期胰腺手术的患者。计算了两个具有临床意义的功能状态评分：存在一个或多个老年特定变量（GSV）和 5 因素修正虚弱指数（mFI-5）。使用 ACS NSQIP 估计的风险进行多变量逻辑回归，以评估术前 GSV、mFI-5 与 30 天结局指标之间的关系。
共纳入 1266 例患者：年龄 65-74 岁 808 例（64%），75-80 岁 302 例（24%），年龄≥81 岁 156 例（12%）；843 例患者接受胰十二指肠切除术。712 例（56%）患者因胰腺腺癌进行手术。年龄较大的患者术后发生并发症的可能性更高（按年龄组分别为 35%、31%和 47%，p=0.004），并且更有可能出院至医疗机构（分别为 12%、23%和 48%，p<0.001）。调整 ACS NSQIP 预测风险后，术前存在 GSV 的患者更有可能需要再次手术和出院至医疗机构（OR 1.81 [95%CI 1.03-3.16]和 3.95 [95%CI 2.91-5.38]）。mFI-5 与术后结局无关（所有 p≥0.18）。
术前 GSV 的存在与择期胰腺切除术后再次手术和出院至专业医疗机构相关。在联合术前决策时应考虑老年特定变量，以优化治疗。
