In-hospital 30-day mortality for older patients with pancreatic cancer undergoing pancreaticoduodenectomy

Walid L. Shaib, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia. Electronic address: wshaib@emory.edu.
Katerina Zakka, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Farhan N. Hoodbhoy, College of Arts and Sciences, Boston University, Boston, MA, United States of America.
Astrid Belalcazar, Eastern Maine Medical Center Cancer Care, Brewer, ME, United States of America.
Sungjin Kim, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
Kenneth Cardona, Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States of America.
Maria C. Russell, Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States of America.
Shishir K. Maithel, Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States of America.
Juan M. Sarmiento, General Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States of America.
Christina Wu, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Mehmet Akce, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Olatunji B. Alese, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Bassel F. El-Rayes, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.

Abstract

OBJECTIVE: Surgical resection remains the only potentially curative therapy for pancreatic ductal adenocarcinoma (PDAC). There is paucity of literature about morbidity and mortality in older patients with PDAC undergoing pancreaticoduodenectomy. This retrospective analysis evaluates the in-hospital 30-day mortality of this population utilizing the Nationwide Inpatient Sample (NIS) database. SUBJECTS AND METHODS: All US patients hospitalized for pancreaticoduodenectomy (Whipple procedure) were included. Data was obtained from the NIS provided by the Agency for Healthcare Research and Quality. Pancreaticoduodenectomy diagnoses were identified using Clinical Classifications Software codes based on ICD-9 between 2007 and 2010. Univariable and multivariable analyses were performed using the logistic model, weighted chi-square test, and generalized linear model. RESULTS: A total of 6149 patient discharges for pancreaticoduodenectomy were identified. Mean age was 64.9 years (SD ± 12.3); 21% of patients were ≥ 76 years of age. Majority were White (N = 5257, 77.9%) with a male:female ratio of 1. Patients aged 76 and older (OR: 1.76; 1.36-2.28; p < .001), Hispanics (OR: 1.40; 0.92-2.13; p = .12), and high comorbidity score (OR: 5.70; 3.44-9.46; p < .001) were found to be associated with a higher risk of 30-day in-hospital mortality. In the multivariable analysis, advanced age (>76) remained a significant predictor of longer in-hospital length of stay (OR: 1.09; 1.04-1.14; p < .001) and 30-day in-hospital mortality (OR 1.46; 1.07-2.00; p = .016). The 30-day in-hospital mortality rate for all patients across all years was 3.24%, for patients >76 years 4.11% and for patients <76 years>2.77%. Patients who underwent surgery at teaching hospitals (OR: 0.61; 0.42-0.88; p = .008) had a lower risk of 30-day in-hospital mortality compared to non-teaching hospitals. CONCLUSION: In-hospital 30 day mortality was higher in selected older patients with PDAC undergoing pancreaticoduodenectomy. Mortality was lower at high volume and teaching centers. Further stringent selection criteria are needed to decrease mortality in the older population.