Skip to main content

Advertisement

SpringerLink
Log in

Association between age and short-term outcomes of gastroenterological surgeries in older patients: an analysis using the National Clinical Database in Japan

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

Based on the data use policy of the Japanese Society of Gastroenterological Surgery (JSGS), data access for the JSGS registry is approved through assessment by the JSGS database committee. Those interested in using the data should contact JSGS database committee (db@jsgs.or.jp) and submit a proposal. The use of JSGS data is granted to approved study proposals and is not publicly accessible.

Code availability

Not applicable

References

  1. Japan Ministry of Internal Affairs and Communications SB. http://www.stat.go.jp/data/topics/topi971.htm

  2. Etzioni DA, Liu JH, Maggard MA, Ko CY (2003) The aging population and its impact on the surgery workforce. Ann Surg 238(2):170–177. https://doi.org/10.1097/01.SLA.0000081085.98792.3d

    Article  PubMed  PubMed Central  Google Scholar 

  3. Turrentine FE, Wang H, Simpson VB, Jones RS (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203(6):865–877. https://doi.org/10.1016/j.jamcollsurg.2006.08.026

    Article  Google Scholar 

  4. Lin HS, Watts JN, Peel NM, Hubbard RE (2016) Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 16(1):157. https://doi.org/10.1186/s12877-016-0329-8

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hewitt J, Long S, Carter B, Bach S, McCarthy K, Clegg A (2018) The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age Ageing 47(6):793–800. https://doi.org/10.1093/ageing/afy110

    Article  PubMed  Google Scholar 

  6. Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, Pawlik TM (2012) Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg 16(9):1727–1735. https://doi.org/10.1007/s11605-012-1938-y

    Article  PubMed  Google Scholar 

  7. Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, Kirkwood KS (2004) Pancreatic resection in the elderly. J Am Coll Surg 198(5):697–706. https://doi.org/10.1016/j.jamcollsurg.2003.12.023

    Article  PubMed  Google Scholar 

  8. Tzeng CW, Cooper AB, Vauthey JN, Curley SA, Aloia TA (2014) Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients. HPB (Oxford) 16(5):459–468. https://doi.org/10.1111/hpb.12155

    Article  Google Scholar 

  9. Duron JJ, Duron E, Dugue T, Pujol J, Muscari F, Collet D, Pessaux P, Hay JM (2011) Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 254(2):375–382. https://doi.org/10.1097/SLA.0b013e318226a959

    Article  PubMed  Google Scholar 

  10. Beltrame V, Gruppo M, Pastorelli D, Pedrazzoli S, Merigliano S, Sperti C (2015) Outcome of pancreaticoduodenectomy in octogenarians: single institution’s experience and review of the literature. J Visc Surg 152(5):279–284. https://doi.org/10.1016/j.jviscsurg.2015.06.004

    Article  CAS  PubMed  Google Scholar 

  11. Bergquist JR, Shubert CR, Ubl DS, Thiels CA, Kendrick ML, Truty MJ, Habermann EB (2016) Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxford) 18(11):900–907. https://doi.org/10.1016/j.hpb.2016.07.012

    Article  Google Scholar 

  12. Kim SY, Weinberg L, Christophi C, Nikfarjam M (2017) The outcomes of pancreaticoduodenectomy in patients aged 80 or older: a systematic review and meta-analysis. HPB (Oxford) 19(6):475–482. https://doi.org/10.1016/j.hpb.2017.01.018

    Article  Google Scholar 

  13. Paulus E, Ripat C, Koshenkov V, Prescott AT, Sethi K, Stuart H, Tiesi G, Livingstone AS, Yakoub D (2017) Esophagectomy for cancer in octogenarians: should we do it? Langenbecks Arch Surg 402(3):539–545. https://doi.org/10.1007/s00423-017-1573-x

    Article  PubMed  Google Scholar 

  14. Nienhueser H, Kunzmann R, Sisic L, Blank S, Strowitzk MJ, Bruckner T, Jäger D, Weichert W, Ulrich A, Büchler MW, Ott K, Schmidt T (2015) Surgery of gastric cancer and esophageal cancer: does age matter? J Surg Oncol 112(4):387–395. https://doi.org/10.1002/jso.24004

    Article  PubMed  Google Scholar 

  15. Otero J, Arnold MR, Kao AM, Schlosser KA, Prasad T, Lincourt AE, Heniford BT, Colavita PD (2019) Short-term outcomes of esophagectomies in octogenarians-an analysis of ACS-NSQIP. J Surg Res 235:432–439. https://doi.org/10.1016/j.jss.2018.07.044

    Article  PubMed  Google Scholar 

  16. Marsoner K, Kornprat P, Sodeck G, Schagerl J, Langeder R, Csengeri D, Wagner D, Mischinger HJ, Haybaeck J (2016) Pancreas cancer surgery in octogenarians - should we or should we not? Anticancer Res 36(4):1979–1984

    PubMed  Google Scholar 

  17. van der Geest LG, Besselink MG, van Gestel YR, Busch OR, de Hingh IH, de Jong KP, Molenaar IQ, Lemmens VE (2016) Pancreatic cancer surgery in elderly patients: balancing between short-term harm and long-term benefit. A population-based study in the Netherlands. Acta Oncol 55(3):278–285. https://doi.org/10.3109/0284186x.2015.1105381

    Article  PubMed  Google Scholar 

  18. Chen K, Pan Y, Maher H, Zhang B, Zheng XY (2018) Laparoscopic hepatectomy for elderly patients: major findings based on a systematic review and meta-analysis. Medicine (Baltimore) 97(30):e11703. https://doi.org/10.1097/md.0000000000011703

    Article  Google Scholar 

  19. Sabate S, Mazo V, Canet J (2014) Predicting postoperative pulmonary complications: implications for outcomes and costs. Curr Opin Anaesthesiol 27(2):201–209. https://doi.org/10.1097/aco.0000000000000045

    Article  PubMed  Google Scholar 

  20. Brueckmann B, Villa-Uribe JL, Bateman BT, Grosse-Sundrup M, Hess DR, Schlett CL, Eikermann M (2013) Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology 118(6):1276–1285. https://doi.org/10.1097/ALN.0b013e318293065c

    Article  PubMed  Google Scholar 

  21. Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA Jr (2004) Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 199(4):531–537. https://doi.org/10.1016/j.jamcollsurg.2004.05.276

    Article  PubMed  Google Scholar 

  22. Studer P, Raber G, Ott D, Candinas D, Schnuriger B (2016) Risk factors for fatal outcome in surgical patients with postoperative aspiration pneumonia. Int J Surg 27:21–25. https://doi.org/10.1016/j.ijsu.2016.01.043

    Article  PubMed  Google Scholar 

  23. Miyata H, Gotoh M, Hashimoto H, Motomura N, Murakami A, Tomotaki A, Hirahara N, Ono M, Ko C, Iwanaka T (2014) Challenges and prospects of a clinical database linked to the board certification system. Surg Today 44(11):1991–1999. https://doi.org/10.1007/s00595-013-0802-3

    Article  PubMed  Google Scholar 

  24. Gotoh M, Miyata H, Hashimoto H, Wakabayashi G, Konno H, Miyakawa S, Sugihara K, Mori M, Satomi S, Kokudo N, Iwanaka T (2016) National Clinical Database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency. Surg Today 46(1):38–47. https://doi.org/10.1007/s00595-015-1146-y

    Article  PubMed  Google Scholar 

  25. Seto Y, Kakeji Y, Miyata H, Iwanaka T (2017) National Clinical Database (NCD) in Japan for gastroenterological surgery: brief introduction. Ann Gastroenterol Surg 1(2):80–81

    Article  Google Scholar 

  26. Takeuchi H, Miyata H, Gotoh M, Kitagawa Y, Baba H, Kimura W, Tomita N, Nakagoe T, Shimada M, Sugihara K, Mori M (2014) A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg 260(2):259–266. https://doi.org/10.1097/sla.0000000000000644

    Article  PubMed  Google Scholar 

  27. Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, Nakagoe T, Shimada M, Kitagawa Y, Sugihara K, Mori M (2014) Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 260(6):1034–1039. https://doi.org/10.1097/sla.0000000000000781

    Article  PubMed  Google Scholar 

  28. Kunisaki C, Miyata H, Konno H, Saze Z, Hirahara N, Kikuchi H, Wakabayashi G, Gotoh M, Mori M (2016) Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer. https://doi.org/10.1007/s10120-016-0634-0

    Article  PubMed  Google Scholar 

  29. Kobayashi H, Miyata H, Gotoh M, Baba H, Kimura W, Kitagawa Y, Nakagoe T, Shimada M, Tomita N, Sugihara K, Mori M (2014) Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database. J Gastroenterol 49(6):1047–1055. https://doi.org/10.1007/s00535-013-0860-8

    Article  PubMed  Google Scholar 

  30. Matsubara N, Miyata H, Gotoh M, Tomita N, Baba H, Kimura W, Nakagoe T, Simada M, Kitagawa Y, Sugihara K, Mori M (2014) Mortality after common rectal surgery in Japan: a study on low anterior resection from a newly established nationwide large-scale clinical database. Dis Colon Rectum 57(9):1075–1081. https://doi.org/10.1097/dcr.0000000000000176

    Article  PubMed  Google Scholar 

  31. Watanabe T, Miyata H, Konno H, Kawai K, Ishihara S, Sunami E, Hirahara N, Wakabayashi G, Gotoh M, Mori M (2017) Prediction model for complications after low anterior resection based on data from 33,411 Japanese patients included in the National Clinical Database. Surgery. https://doi.org/10.1016/j.surg.2016.12.011

    Article  PubMed  Google Scholar 

  32. Kenjo A, Miyata H, Gotoh M, Kitagawa Y, Shimada M, Baba H, Tomita N, Kimura W, Sugihara K, Mori M (2014) Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 218(3):412–422. https://doi.org/10.1016/j.jamcollsurg.2013.11.007

    Article  PubMed  Google Scholar 

  33. Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, Shimada M, Baba H, Tomita N, Nakagoe T, Sugihara K, Mori M (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259(4):773–780. https://doi.org/10.1097/sla.0000000000000263

    Article  PubMed  Google Scholar 

  34. Takesue Y, Miyata H, Gotoh M, Wakabayashi G, Konno H, Mori M, Kumamaru H, Ueda T, Nakajima K, Uchino M, Seto Y (2019) Risk calculator for predicting postoperative pneumonia after gastroenterological surgery based on a national Japanese database. Ann Gastroenterol Surg 3(4):405–415. https://doi.org/10.1002/ags3.12248

    Article  PubMed  PubMed Central  Google Scholar 

  35. Aoki S, Miyata H, Konno H, Gotoh M, Motoi F, Kumamaru H, Wakabayashi G, Kakeji Y, Mori M, Seto Y, Unno M (2017) Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan. J Hepatobiliary Pancreat Sci 24(5):243–251. https://doi.org/10.1002/jhbp.438

    Article  PubMed  PubMed Central  Google Scholar 

  36. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

  37. Vogt AW, Henson LC (1997) Unindicated preoperative testing: ASA physical status and financial implications. J Clin Anesth 9(6):437–441

  38. Mengardo V, Cormack OM, Weindelmayer J, Chaudry A, Bencivenga M, Giacopuzzi S, Allum WH, de Manzoni G (2018) Multicenter study of presentation, management, and postoperative and long-term outcomes of septegenerians and octogenerians undergoing gastrectomy for gastric cancer. Ann Surg Oncol 25(8):2374–2382. https://doi.org/10.1245/s10434-018-6543-1

    Article  PubMed  Google Scholar 

  39. Sakamoto K, Oka M, Yoshino S, Hazama S, Takeda S, Yoshimura K, Okayama N, Hinoda Y (2014) Relationship between cytokine gene polymorphisms and risk of postoperative pneumonia with esophageal cancer. J Gastrointest Surg 18(7):1247–1253. https://doi.org/10.1007/s11605-014-2531-3

    Article  PubMed  PubMed Central  Google Scholar 

  40. Soutome S, Yanamoto S, Funahara M, Hasegawa T, Komori T, Oho T, Umeda M (2016) Preventive effect on post-operative pneumonia of oral health care among patients who undergo esophageal resection: a multi-center retrospective study. Surg Infect (Larchmt) 17(4):479–484. https://doi.org/10.1089/sur.2015.158

    Article  Google Scholar 

  41. Okamura A, Watanabe M, Mine S, Nishida K, Kurogochi T, Imamura Y (2016) Spirometric lung age predicts postoperative pneumonia after esophagectomy. World J Surg 40(10):2412–2418. https://doi.org/10.1007/s00268-016-3547-5

    Article  PubMed  Google Scholar 

  42. Haga Y, Ikei S, Wada Y, Takeuchi H, Sameshima H, Kimura O, Furuya T (2001) Evaluation of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to predict postoperative risk: a multicenter prospective study. Surg Today 31(7):569–574. https://doi.org/10.1007/s005950170088

    Article  CAS  PubMed  Google Scholar 

  43. Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78(3):355–360. https://doi.org/10.1002/bjs.1800780327

    Article  CAS  PubMed  Google Scholar 

  44. Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F, Fonck M, Soubeyran PL (2012) Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 23(8):2166–2172. https://doi.org/10.1093/annonc/mdr587

    Article  CAS  PubMed  Google Scholar 

  45. Fariña-Castro R, Roque-Castellano C, Artiles-Armas M, Marchena-Gómez J (2019) Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients. Geriatr Gerontol Int 19(4):293–298. https://doi.org/10.1111/ggi.13624

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kiyohiko Omichi, Kiyoshi Hasegawa & Norihiro Kokudo

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiraku Kumamaru & Hiroaki Miyata

  3. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan

    Hiroaki Miyata

  4. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Hiroyuki Konno

  5. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yasuyuki Seto

  6. The Japan Surgical Society, Tokyo, Japan

    Masaki Mori

  7. Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan

    Norihiro Kokudo

Authors
  1. Kiyohiko Omichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kiyoshi Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiraku Kumamaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroaki Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroyuki Konno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasuyuki Seto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Norihiro Kokudo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: K.O., K.H., H.Kumamaru, N.K. Acquisition of data: H.Kumamaru, H.M., Y.S. Analysis and interpretation of data: K.O., K.H., H.Kumamaru. Drafting of manuscript: K.O., K.H., H.Kumamaru, N.K. Critical revision of manuscript: K.O., K.H., H.Kumamaru, H.M., H.Konno, Y.S., M.M., N.K.

Corresponding author

Correspondence to Kiyoshi Hasegawa.

Ethics declarations

Ethics approval

Academic use of the registered NCD data for retrospective studies has been approved by the Institutional Review Board of the Japan Surgical Society.

Consent to participate

Informed consent was obtained in the form of opt-out on the institute’s website.

Consent for publication

Not applicable

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Supplementary file2 (DOCX 110 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Omichi, K., Hasegawa, K., Kumamaru, H. et al. Association between age and short-term outcomes of gastroenterological surgeries in older patients: an analysis using the National Clinical Database in Japan. Langenbecks Arch Surg 406, 2827–2836 (2021). https://doi.org/10.1007/s00423-021-02296-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02296-5

Keywords

Search

Navigation