M. G. Neuwirth1, A. J. Sinnamon1, D. L. Fraker1, R. R. Kelz1, R. E. Roses1, G. C. Karakousis1 1Hospital Of The University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction: While there is the general perception as the population ages that we are operating on older patients for cancer, there is little data on trends in major resections for cancer in this population when adjusted for cancer incidence and short-term outcomes in this group.
Methods: The Nationwide Inpatient Sample was used to estimate the national trends of major abdominal resections for cancer in octogenarians from 2000 through 2011 including pancreatic resections, total gastrectomies, hepatectomies, and total colectomies. Partial resections of the stomach, colon and liver lobes were excluded in order to target a subset of elderly patients undergoing comparably morbid procedures. Rates of resections performed per year were incidence-adjusted to the US incidence among octogenarians for each cancer type as determined by the SEER registry. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) when evaluating trends over time.
Results:Over the study period, an estimated 17,002 major abdominal organ resections for cancer were performed in patients 80 or older in the U.S, 44.2% were pancreatic resections, with 27.9% total gastrectomies, 18.2% total colectomies 9.5% and major liver resections. The estimated number of resections per year in the elderly increased substantially over time from 732 in 2000 to 1848 in 2011 (APC=8.0%, p<.01) along with an increase in Elixhauser comorbidities in this group from a mean of 2.3 in 2000 to 3.4 in 2011 (APC=3.5, p<.001). However, inpatient mortality during this time decreased in octogenarians from 23.5% to 18.1% (AAPC=-1.8, p<.001) with the most significant decrease over the latest 5 years of 2007 to 2011 (APC =-6.97, p<.001). Pancreatic resections increased at the fastest rate in elderly patients, APC=11.3, p<.001, fatality rates decreased from 15.6 to 7.8% (APC= -6.2, p<.001). Major liver resections and total with incidence of pancreatic cancers in this age group increasing by 21.2% and colectomies increased slightly (APC=4.28, p=.1 and APC=3.37 p<.001 respectively). Total gastrectomies for cancer decreased over time in this population, although the trend was not significant (APC=-.5, p=.8), and fatality rates also decreased during this time from 17.1 to 12.6%, with a significant decrease over time from 2004 to 2011 (APC=-8.0, p<.001).
Conclusion:Major abdominal resections for cancer are increasing over time in octogenarians at a disproportionally higher rate than respective increases in incidences of cancer diagnoses, and with a concurrent significant decrease in 30-day in-patient mortality rates. This pattern may suggest a shifting selection criterion for elderly surgical patients with time.
