C. Bierema1, A. J. Sinnamon1, C. E. Sharoky1, C. J. Wirtalla1, R. E. Roses1, D. L. Fraker1, R. R. Kelz1, G. C. Karakousis1 1University Of Pennsylvania,Philadelphia, PA, USA
Introduction: The relationship between patient age and timing of postoperative complication is unknown. We hypothesized that advanced patient age may be associated with later presentation of certain common complications following major abdominal surgery.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program (2001-2011) was used to evaluate timing of postoperative complications in patients undergoing elective major abdominal surgery (colectomy, gastrectomy, hepatectomy, and pancreatectomy). The Jonckheere-Terpstra test was used to assess for significant trends in age and later median postoperative day of complications. Multivariable linear regression adjusting for patient factors was then performed to examine the association between older age and timing of postoperative complications.
Results:
A total of 108,689 patients met inclusion criteria. There were 8,834 patients <40y (8%), 54,040 patients 40-65y (50%), 36,834 patients 66-80y (34%), and 8,891 patients >80 y (8%). More than half the patients (58%, n=63,004) underwent colectomy. The remainder of the cohort underwent pancreatectomy (26% n=28,388), hepatectomy (10% n=10,687), and gastrectomy (6% n=6,610). Significant differences in comorbid status by age group were observed. Before adjustment for patient factors, the median number of days to complication for urinary tract infection (p<0.001), pneumonia (p<0.001), superficial surgical site infection (p<0.001) and deep/organ space surgical site infection (p=0.046) was significantly longer with increasing age (see figure). There was no significant difference between median days to complication and age for venous thromboembolism, cardiac or renal complications. After adjustment for patient factors, a significant association between older age and later median day of complication presentation was only observed for urinary tract infection (p<0.001) and pneumonia (p<0.001). Other patient factors being equal, patients >80 years of age presented on average 2.56 days later with urinary tract infection and 1.46 days later with pneumonia than patients <40 years of age.
Conclusion: Urinary tract infection and pneumonia present later postoperatively with increasing age. Further study is needed to delineate whether these represent biological differences or delay in diagnosis, as elderly patients may not present with the same classic symptoms as younger patients. Recognition of these trends is important in the postoperative care of elderly patients, which is particularly relevant with the aging population.
