M. N. Mustian1, L. E. Goss1, D. Chu1, L. Theiss1, J. Christein1, C. Balentine1, M. S. Morris1 1University Of Alabama At Birmingham,Surgery,Birmingham, AL, USA
Introduction: More than one third of operations in the United States are performed on individuals aged 65 years or older. These patients are at high risk for unplanned readmission, prolonged hospitalization, and postoperative complications. This study analyzes the relationship between aging and perioperative outcomes for patients undergoing pancreatectomy and colectomy at a major academic medical center. We hypothesize that elderly patients would have higher rates of readmission and worse postoperative outcomes.
Methods: We used National Surgical Quality Improvement Project data from our institution to evaluate 1964 patients having colectomy or pancreatectomy between 2010 and 2016. We stratified by age: < 50, 50-59, 60-69, 70-79, and ≥80 years old. The primary endpoint was 30 day unplanned postoperative readmission. Secondary endpoints included length of stay, mortality, postoperative readmission rates and NSQIP complications. Univariate and multivariate analysis were performed. We used stepwise backwards logistic regression analyses to identify risk factors for readmission.
Results: In our cohort of 1964 patients, 692 (35%) patients had pancreatectomies and 1272 (65%) colectomies. The age distribution included: 23% age <50, 26% age 50-59, 28% age 60-69, 17% age 70-79 and 6% age 80 and older. Median postoperative length of stay was 6 days and was similar across all age groups. Median readmission rate was 13.6% and similar across age groups. Major complications were observed in 216 patients and resulted in different rates of readmission based on age (<65 years 40% vs ≥65 years 27% p=0.03). The risk of mortality increased steadily with age from <1% in the youngest group to 4.2% in the oldest group. On multivariable analysis, there was no significant relationship between age and risk of readmission, but both minor (OR 1.76 CI 1.15-2.68) and major (OR 4.6 CI 3.2-6.5) complications were associated with increased odds of readmission.
Conclusion: Our data did not reveal an association between age and risk of readmission. Postoperative complications are associated with readmission. However, younger patients experiencing major complications were more likely to be readmitted when compared to older patients. Reasons for readmission in elderly patients may differ from those of younger patients. Further work is needed to understand the relationship between age and readmission to design programs to address the unique discharge needs of elderly patients.
