J. Otero1, M. R. Arnold1, A. M. Kao1, K. A. Schlosser1, T. Prasad1, A. E. Lincourt1, B. T. Heniford1, P. D. Colavita1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction: In the face of an increasing aged population, the surgical management of esophageal disease in the elderly will increase. Little data exists regarding esophagectomy outcomes in the elderly. The aim of this study was to assess the short-term outcomes of esophagectomies in octogenarians.
Methods: National Surgical Quality Improvement Program database from 2005-2014 was queried for patients who underwent esophagectomy. Preoperative, intraoperative, and postoperative variables were evaluated. Patients ≥80 and <80 years old were compared in univariate and multivariate analysis controlling for obesity, smoking, functional status, dyspnea, chronic obstructive pulmonary disease, hypertension, steroid use, bleeding disorders, weight loss, and ASA.
Results: Among 6454 esophagectomies, 290 (4.5%) were performed in patients ≥80 years of age. Trans-thoracic esophagectomies predominated in both age groups (51% & 60%), with trans-hiatal being the next most common (36% & 27%). Mean age for the younger group was 62, compared to 82 in the older group. Octogenarians were more likely to enter surgery with comorbidities of HTN (70% vs 50%, p<0.0001), TIA (5.7% vs 1.9%, p=0.0024), and bleeding disorder (6.6% vs 3.8%, p=0.0164). There were also increased frequency of prior cardiac procedures (PCI 13.5% vs 7.4%, p=0.0086 & cardiac surgery 15.6% vs 6.1%, p<0.0001). Elderly patients were less likely to have independent functional status (94.1% vs 98.4%, p<0.0001), and had higher ASA (p=0.0186). Operative time was shorter for the elderly (mean 320min vs 354min, p<0.0001).
No differences were noted in wound events (10% vs 11%, p=0.5772) and minor or major complications (33.7% vs 32.3%, p=0.6306 & 42.6% vs 38.5%, p=0.1718). Postoperative sepsis occurred in 9% of patients in both groups (p=0.9672) while septic shock was noted in 8.6% of octogenarians and 6.5% of younger patients (p=0.1636). Postoperative myocardial infarction occurred in 2% of elderly and 1% of younger patients (p=0.0624). VTE rates were similar (DVT 2.4% vs 4%, p=0.7887 & PE 1% vs 2%, p=0.2477). There was no difference in rates of return to the OR (14%, p=0.9848) between groups. Amongst the different surgical approaches, trans-thoracic demonstrated increased rates of postoperative MI in the elderly (2.72% vs 0.86%, p=0.0469). Using multivariate analysis, no difference in length of stay was noted between the two groups (p=0.2355). Age was independently associated with worse outcomes in the elderly for postoperative respiratory complications (OR 1.39; CI 1.06-1.83), 30-day mortality (OR 1.73; CI 1.01-2.95), and discharge to facility other than home (OR 3.3698; CI 2.62-5.22).
Conclusion: Esophagectomies in the very elderly is feasible, with increased risk of postoperative respiratory complications, 30-day mortality, and discharge to a new facility for increased patient needs. Cardiac outcomes with trans-thoracic approach may be worse in the elderly.