M. Perez1, R. Grim1, T. Bell1, J. Martin1, V. Ahuja1 1York Hospital,York, PA, USA
Introduction: As lifespan increases, care for octogenarian patients will be paramount as living longer will result in more surgical procedures for this cohort. Colorectal resection in elderly patients has been associated with increased morbidity and mortality especially in non-elective cases. While obesity and higher mortality in older adults has not been observed consistently, some research indicates that mortality may be lower in older adults who are obese compared to non-obese – this is known as the obesity paradox. The purpose of this study was to 1) evaluate characteristics associated with octogenarians receiving colectomy, specifically in the obese population, 2) determine protective factors for all patients, and 3) assess mortality by body mass index (BMI) in octogenarians.
Methods: Data were obtained from the ACS-NSQIP Participant User File (2011 and 2012) for CPT codes that included open partial colectomy, abdominoperineal resection, and total colectomy. Age was categorized as 40-64, 65-79, and 80-89 (octogenarians). BMI was categorized as normal, overweight and obese. Variables of interest were gender, race, transfer status, residency supervision, wound infection, steroid use, bleeding disorder, transfusion, chemotherapy, radiotherapy, sepsis, prior operation, emergent case, wound classification, ASA, elective surgery, CPT, and mortality.
Results: 31,593 cases identified (40-64 = 49.5%; 65-79 = 36.4%; octogenarian = 14.1%). Compared to younger cohorts, octogenarians were predominately white (79.7%), female (59.6%), normal BMI (44.6%), non-elective cases 27.4%, and had higher ASA classification of 3 (61.4%). They were less likely to be admitted from home 85.3%, with a high proportion from nursing or acute care home (10.8%). Octogenarians were more likely to die in the hospital (8.9%) than 40-64 (2.3%) and 65-79 (5%). For all patients regardless of age, logistic regression indicated that transferred from home (OR 1.8) and obesity (OR 1.4) were predictive of living (all p<0.05). While obese people were more likely to die overall, obese octogenarians had the lowest mortality rate (21.4%) compared to obese 40-64 year olds (44.4) and 65- 79 year olds (40.6%), p<.001 (Graph 1). In addition, obese octogenarians had significantly fewer complications (M=2.67) than obese 40-64 year olds (M=3.05), p<.001.
Conclusion: Octogenarians were more likely to die from colectomy, but mortality and complications were lower for obese octogenarians, which supports the obesity paradox; a phenomenon that has not been studied exclusively in colectomy patients. In the future with further research these independent factors can help surgeons stratify risks for octogenarians undergoing colectomies.
