L. Theiss1, L. Goss1, D. I. Chu1, M. Morris1 1University Of Alabama At Birmingham,Department Of Surgery,Birmingham, Alabama, USA
Introduction: Surgeons are operating on a growing population of elderly adults. Elderly patients are defined in most studies as anyone greater than 65 years. Few studies have characterized the elderly population by age groups. We hypothesize that increasing age is associated with worse post-operative outcomes including readmission.
Methods: We queried the 2011-2013 National Surgical Quality improvement Program (NSQIP) cohort for patients who underwent an elective colectomy and stratified them into age categories: 18-50, 51 to 60, 61 to 70, 71 to 80, and over 80. Univariate and bivariate comparisons analyses were performed. Using backwards logistic regression, we adjusted for difference in demographics, surgical characteristics, co-morbidities, and complications to identify independent predictors for readmission.
Results: Of the 70,843 patients who underwent elective colorectal surgery: 19.4% were under 50, 22.9% were 51 to 60, 25.5% were 61 to 70, 19.9% were 71 to 80, and 12.3% were over 80,.52.7% were women. Patients over 80 were primarily independent (90.2%) and had the longest length of stay (7 days, p<0.01) compared to all other age groups. The most frequent operation in this cohort was partial colectomy (40.4%), followed by LAR/DLI (34.6%), ileocecectomy (18.3%), and total colectomy (4.2%). Almost half of all colectomies were performed laparoscopically (46.5%). Post-operative outcomes differed significantly based on age (Table 1). Overall SSI rate was 8.4% and was the lowest in patients >80 years old (6.6%). Mortality rates increased with increasing age. Individuals under 50 had the highest readmission rate (12.3%) while individuals age 50-60 had the lowest (9.9%). In the fully adjusted model, patients under 50 years of age (OR 1.2 CI 1.1-1.3) and over 80 years of age (OR 1.14 CI 1.03-1.26) had a significantly higher chance of readmission.
Conclusion: Patients over 80 years and those under age 50 have the highest risk of readmission following elective colorectal surgery. Increasing age is also associated with increased mortality and increased hospital length of stay. As post-operative outcomes including readmission are being used as a quality metric, age of the patient undergoing the procedure should be considered.
