Functional Status Determines Postoperative Outcomes In Elderly Patients Undergoing Hepatic Resections

Background With the aging population and increasing incidence of hepatic malignancies in elderly patients, establishing the safety of hepatic resections is crucial. The present study investigates early postoperative morbidity and mortality in elderly patients undergoing hepatic resection using a nationally validated database. Methods The National Surgical Quality Improvement Program Participant User Files (NSQIP-PUF) for 2005-2009 were used for the retrospective analysis of all patients undergoing hepatic resection. The primary outcome measures were 30-day postoperative mortality, overall complication rate, and serious complication rate. The primary predictor variable was patient age, which was treated as a dichotomous variable (age ≤70 years, age ≥70 years). Results Five thousand seven hundred six patients were included in the final analysis, 1,280 of which were ≥70 years of age. Thirty-day postoperative mortality (≤70 years 1.9% vs. ≥70 years 4.5%, P \u3c 0.0001), serious complications (≤70 years 15.2% vs. ≥ 70 years 18.4%, P \u3c 0.006) and overall complications (≤70 years 23.1% vs. ≥70 years 26.6%, P \u3c 0.01) were more common in the elderly group. Elderly patients had significantly more wound infections, pneumonia, prolonged ventilator support, unplanned re-intubations, renal failure, strokes, myocardial infarction, cardiac arrests, and septic shock. The median length of hospitalization was also significantly longer in the elderly. Conclusions This study shows significantly higher complication rates and mortality following hepatic resections in elderly patients. These findings should be taken into account when considering hepatectomy in this population. © 2013 Wiley Periodicals, Inc