The impact of advanced age on short-term outcomes following gastric cancer resection: an ACS-NSQIP analysis
- 139 Downloads
Evidence on short-term outcomes for GC resection in elderly patients is limited by small samples from single-institutions. This study sought to examine the association between advanced age and short-term outcomes of gastrectomy for gastric cancer (GC).
Using ACS-NSQIP data, patients undergoing gastrectomy for GC (2007–2013) were identified. Primary outcome was 30-day major morbidity. Outcomes were compared across age categories (<65, 65–70, 71–75, 76–80, >80 years old). Univariable and multivariable regression was used to estimate the morbidity risk associated with age.
Of 3637 patients, 60.6% were ≥65 years old. Major morbidity increased with age, from 16.3% (<65 years old) to 21.5% (76–80 years old), and 24.1% (>80 years old) (p < 0.001), driven by higher respiratory and infectious events. Perioperative 30-day mortality increased from 1.2% (<65years old) to 6.5% (>80 years old) (p < 0.0001). After adjustments, age was independently associated with morbidity for 76–80 years of age (RR 1.31, 95% CI, 1.08–1.60) and >80 years old (RR 1.49, 95% CI, 1.23–1.81). Predicted morbidity increased by 18.6% in those 75–80 years old and 27.5% in those >80 years old (compared to <65 years old) for total gastrectomy, and by 11.6% and 17.2% for subtotal gastrectomy, for worst case scenario. Morbidity increased by 5.1% in those 75–80 years old and 7.6% in those >80 years old for total gastrectomy, and by 3.1% and 4.7% for subtotal gastrectomy, for best case scenario.
Advanced age, defined as more than 75 years, was independently associated with increased morbidity after GC resection. The magnitude of this impact is further modulated by clinical scenarios. Increased risk in elderly GC patient should be recognized and considered in indications for resection.
KeywordsGastric cancer Resection Elderly Morbidity Mortality
Compliance with ethical standards
Conflict of interest
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The authors have no conflict of interest to disclose.
Approval was sought through the Sunnybrook Health Sciences Centre Research Ethics Board, and the study was deemed to be exempt.
- 13.Hwang SH, Park Do Joong, Jee YS, Kim H-H, Lee H-J, Yang H-K, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. JACS. 2009;208:186–92.Google Scholar
- 17.Yang J-Y, Lee H-J, Kim TH, Huh Y-J, Son Y-G, Park J-H, et al. Short- and long-term outcomes after gastrectomy in elderly gastric cancer patients. Ann Surg Oncol. 2016;24:1–9.Google Scholar
- 24.Davenport DL, Holsapple CW, Conigliaro J. Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University Health System Consortium Clinical Database and the National Surgical Quality Improvement Program data set. Am J Med Qual. 2009;24:395–402.CrossRefPubMedGoogle Scholar
- 26.Elmi M, Mahar A, Kagedan D, Law CHL, Karanicolas PJ, Lin Y, et al. The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Can J Surg Can Med Assoc. 2016;59:322–9.CrossRefGoogle Scholar
- 27.Hallet J, Mahar AL, Tsang ME, Lin Y, Callum J, Coburn NG, et al. The impact of peri-operative blood transfusions on post-pancreatectomy short-term outcomes: an analysis from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxf). 2015;17(11):975–82.CrossRefGoogle Scholar
- 32.United Nations. Ageing [Internet]. United Nations. [cited 2017 May]. https://www.un.org/en/sections/issues-depth/ageing/index.html.
- 33.The World Health Organization. World report on ageing and health [Internet]. 2015 [cited 2017 May]. https://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1.
- 35.Matsushita I, Hanai H, Kajimura M, Tamakoshi K, Nakajima T, Matsubayashi Y, et al. Should gastric cancer patients more than 80 years of age undergo surgery? comparison with patients not treated surgically concerning prognosis and quality of life. J Clin Gastroenterol. 2002;35:29–34.CrossRefPubMedGoogle Scholar
- 41.Lyle B, Landercasper J, Johnson JM, Al-Hamadani M, Vang CA, Groshek J, et al. Is the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator applicable for breast cancer patients undergoing breast-conserving surgery? Am J Surg. 2016;211:820–3.CrossRefPubMedGoogle Scholar