F. Schlottmann1, P. D. Strassle1, B. A. Cairns1, M. G. Patti1 1University Of North Carolina,Surgery,Chapel Hill, NORTH CAROLINA, USA
Introduction: The progressing aging of the population in conjunction with the higher incidence of esophageal cancer will dramatically increase the number of elderly patients with esophageal cancer. We aimed to determine the postoperative outcomes after esophagectomy for cancer in elderly patients.
Methods: A retrospective, population-based analysis was performed using the National Inpatient Sample for the period 2000-2014. Adult patients (≥18 years old) diagnosed with esophageal cancer and who underwent esophagectomy during their inpatient hospitalization were included. Patients were categorized into <70 years old (yo) and ≥70 yo. Multivariable linear and logistic regression, adjusting for admit year, gender, race, comorbidities, primary insurance, household income, hospital region, hospital teaching status, and hospital size, were used to assess the potential effect of age on length of stay, hospital charges, and patient complications. The predicted probability of inpatient mortality was also estimated using multivariable logistic regression, where age was treated as a restricted cubic spline.
Results: Overall, 5,243 patients were included, with 3,699 (70.6%) <70 yo and 1,544 (29.5%) ≥70 yo. Elderly patients were more likely to be female and have comorbidities. The yearly rate of esophagectomies among patients ≥70 yo did not significantly changed during the study period (28.4% in 2000 and 26.3% in 2014, p=0.76). No significant differences in the incidence of postoperative venous thromboembolism, wound complications, infection, bleeding, renal failure, respiratory failure, shock, or average length of stay were seen. Elderly patients were significantly more likely have postoperative cardiac failure (OR 1.59, 95% CI 1.21, 2.09, p=0.0009) and postoperative mortality (OR 1.84, 95% CI 1.39, 2.45, p< 0.0001). The predicted probability of mortality also exponentially increased with age (1.5% in 40 yo, 2.5% in 50 yo, 3.6% in 60 yo, 5.4% in 70 yo, and 7.0% in 80 yo), Figure 1. Among elderly patients, hospital charges were, on average, $16,320 greater (95% CI $3,110, $29,530) than patients <70 yo, p=0.02.
Conclusion: Elderly patients undergoing esophagectomy for cancer have a high risk of postoperative mortality and have a higher expense burden on the health care system. Elderly patients with esophageal cancer should be carefully selected for surgery.
