S. Groene1, C. Chandrasekera1, T. Prasad1, A. Lincourt1, B. T. Heniford1, V. Augenstein1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction: The general belief concerning elderly patients undergoing surgery is that they are at higher risk for post-operative complications than their younger counterparts. Few studies, however, differentiate age from the associated co-morbidities of aging. The aim of this study was to compare outcomes of patients undergoing colorectal resection stratified by age.
Methods: An extensive review for colorectal procedures performed from 2013 to 2015 at a single institution was conducted utilizing a NSQIP database. Patients who were ≤60 years old were compared to those who were ≥75 years old. Demographics, pre-operative co-morbidities, minor and major complications, and mortality were evaluated using standard statistical methods.
Results: Over the 2 years, 373 patients qualified for the study; 278 were ≤60 years, and 95 were ≥75 years. Mean age for the younger group was 47.8±9.7 vs 80.8±4.4 for the older group. BMI was 28.8±8.3 vs 25.6±4.5 (p=0.003), respectively. Both groups were similar in gender and race. The older patients tended to be more hypertensive (72.6% vs 33.8%; p<0.001) with higher rates of diabetes (22.1% vs 8.6%; p<0.001) and COPD (14.7% vs 1.8%). In the older group, 81.1% were ASA class 3-4 vs 45% in the younger group (p<0.001). The younger group had a higher rate of smokers (26.3% vs 7.4%; p<0.001). There was no difference in the percentage of laparoscopic cases; however, the older group underwent more right-sided colectomies (55.7% vs 31.2%; p<0.001) and more emergent cases (16.8% vs 8.6%; p=0.03). The older group required more post-operative transfusions (24.2% vs 13.7%; p=0.02), had a higher rate of 30 day mortality (6.3% vs 1.1%; p=0.01) and had a longer post-operative length of stay (11.7±8.4 days vs 9.5±9.6 days; p<0.001). However, after controlling for ASA class and emergent surgery status, multivariate analysis indicated that there were no significant differences between the older or younger groups in terms of post-op transfusions or LOS. Given the low incidence of deaths (N=9), MV analysis was not feasible for this outcome. There were no differences in post-operative surgical site infections, pneumonia, urinary tract infection, myocardial infarction, renal failure, DVT/PE, unplanned intubations, anastomotic leak, unplanned return to the OR and mortality after 30 days between older and younger patients.
Conclusion: Patients who were ≥75 years old had a higher prevalence of pre-operative co-morbidities and required more emergent operations. After controlling for ASA class and emergent status, there was no significant difference in outcomes between patients ≤60 years old or those ≥75 years old. The perception of increased risk of surgery associated with elderly patients appears to related to their pre-op comorbidities rather than their age.