R. C. Langan1,2, K. Harris1,2,3, C. Zheng1, R. Verstraete4, W. B. Al-Refaie1,2,3, L. B. Johnson1,2,3 1Georgetown University Hospital,Department Of Surgery,Washington, DC, USA 2MedStar-Georgetown Surgical Outcomes Research Center,Washington, DC, USA 3MedStar Health Research Institute,Washington, DC, USA 4Georgetown University Hospital,Washington, DC, USA
Introduction: Studies examining post-pancreaticoduodenectomy (PD) operative outcomes in patients older than 80-years have found higher complications, longer length of stay (LOS) and higher mortality. However, there is limited data reporting hospital resources consumed in caring for the oldest-old. We examined the use of PD-relevant hospital resources in patients treated in high-volume-hospitals (HVH) participating in the University HealthSystem Consortium (UHC).
Methods: Using the UHC database, we identified 210 U.S. hospitals performing ≥ 12 PD/year between 2010 and 2014. We compared mortality, complications, ICU-use, TPN-use, blood transfusions, LOS, readmissions and direct costs by increasing age groups. Index hospitals performed a total of 12,766 PDs (< 70 years n=8,564, 70-79 years n=3,302, ≥ 80 years n=900). We used linear regression models with and without adjusting for covariates to assess the impact of older age. Hospital means were weighted based on age-specific procedure volume.
Results: Compared to younger patients, those ≥ 80-years experienced more cardiopulmonary, genitourinary and infectious complications, more blood transfusions, greater TPN use, longer LOS and higher direct costs (Table 1). However, they experienced fewer readmissions and had equivalent ICU-use and mortality rates to both younger cohorts.
Conclusion: With growing pressure to control and reduce hospital costs, it is imperative to identify, understand, and modify factors that contribute to elevated resource use both within the hospitals and post-discharge. We found increased resource utilization in the oldest-old as compared to younger patients. However, the oldest-old had comparable mortality and intensive care use, fewer readmissions and as compared to septuagenarians had no differences in TPN-use or direct costs. Our findings suggest that substantial differences in resource use may underlie otherwise comparable clinical outcomes.
