TY - JOUR
T1 - Association between age and short-term outcomes of gastroenterological surgeries in older patients
T2 - an analysis using the National Clinical Database in Japan
AU - Omichi, Kiyohiko
AU - Hasegawa, Kiyoshi
AU - Kumamaru, Hiraku
AU - Miyata, Hiroaki
AU - Konno, Hiroyuki
AU - Seto, Yasuyuki
AU - Mori, Masaki
AU - Kokudo, Norihiro
N1 - Funding Information:
The authors would like to thank all the gastroenterological surgeons, data managers, and hospitals for participating in the NCD project and for their great efforts in entering data. We are also grateful to the late Dr. Toshiaki Watanabe for his assistance.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: The association between advanced age and postoperative morbidity and mortality after major gastroenterological surgeries remains unclear. This study aimed to assess the association between old age and the short-term postoperative outcomes of gastroenterological surgeries. Methods: We evaluated 327,642 patients who underwent any of the seven major gastroenterological surgeries—esophagectomy, total gastrectomy, distal gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, and pancreatoduodenectomy—and were registered with the Japanese national surgical registry between January 2011 and December 2013. Perioperative characteristics, frequency/nature of postoperative morbidities, and postoperative mortality were compared according to age at the time of surgery. Results: Overall, 18% (59,182/327,642) of the entire cohort were aged ≥ 80 years. The overall mortality rates in the entire cohort and in those aged ≥ 80 years were 1.7% and 3.3%, respectively. The postoperative mortality increased with increasing age for all procedures, with the trend persisting even after adjusting for various confounding factors. The incidence of postoperative pneumonia increased with increasing age, and with all procedures, except esophagectomy, subjects aged ≥ 80 years had a markedly higher risk of developing postoperative pneumonia than those aged < 60 years. Conclusion: Advanced age is associated with significantly worse short-term outcomes in older patients undergoing gastroenterological surgeries. However, we could not identify any distinct cutoff age beyond which major gastroenterological surgery could be considered as being contraindicated. The mortality risk should be carefully considered before recommending major gastroenterological surgeries for older patients.
AB - Purpose: The association between advanced age and postoperative morbidity and mortality after major gastroenterological surgeries remains unclear. This study aimed to assess the association between old age and the short-term postoperative outcomes of gastroenterological surgeries. Methods: We evaluated 327,642 patients who underwent any of the seven major gastroenterological surgeries—esophagectomy, total gastrectomy, distal gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, and pancreatoduodenectomy—and were registered with the Japanese national surgical registry between January 2011 and December 2013. Perioperative characteristics, frequency/nature of postoperative morbidities, and postoperative mortality were compared according to age at the time of surgery. Results: Overall, 18% (59,182/327,642) of the entire cohort were aged ≥ 80 years. The overall mortality rates in the entire cohort and in those aged ≥ 80 years were 1.7% and 3.3%, respectively. The postoperative mortality increased with increasing age for all procedures, with the trend persisting even after adjusting for various confounding factors. The incidence of postoperative pneumonia increased with increasing age, and with all procedures, except esophagectomy, subjects aged ≥ 80 years had a markedly higher risk of developing postoperative pneumonia than those aged < 60 years. Conclusion: Advanced age is associated with significantly worse short-term outcomes in older patients undergoing gastroenterological surgeries. However, we could not identify any distinct cutoff age beyond which major gastroenterological surgery could be considered as being contraindicated. The mortality risk should be carefully considered before recommending major gastroenterological surgeries for older patients.
KW - Gastroenterological surgery
KW - Morbidity
KW - Mortality
KW - National Clinical Database
KW - Older age
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U2 - 10.1007/s00423-021-02296-5
DO - 10.1007/s00423-021-02296-5
M3 - Article
C2 - 34379197
AN - SCOPUS:85112333716
VL - 406
SP - 2827
EP - 2836
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
SN - 1435-2443
IS - 8
ER -