Risk Factors and Surgical Outcomes of Older Adult Patients Undergoing a Whipple Procedure.

Abstract

Objectives: The Whipple procedure, or pancreatoduodenectomy with pancreatojejunostomy, can result in adverse outcomes among older adult patients with lower physiological reserves. As such, we studied the differences in comorbidities and postoperative outcomes between older adult and younger (nonolder adult) populations following Whipple procedures.

Methods: We compared clinical factors of 1553 older adult (70 years and older) and 2171 younger adult patients (18-69 years) who underwent a Whipple procedure using the 2021 American College of Surgeons National Surgical Quality Improvement Program databases.

Results: The older adult cohort had higher rates of cancer diagnosis (58.02% vs 50.99%), diabetes mellitus (31.49% vs 26.07%), congestive heart failure (2.38% vs 1.29%), hypertension (67.80% vs 44.13%), and American Society of Anesthesiologists class ≥3 (89.83% vs 80.01%). The older adult cohort also had higher rates of postoperative mortality (1.35% vs 0.69), pneumonia (3.73% vs 2.12%), transfusions (20.15% vs 17.00%), and delayed gastric emptying (16.61% vs 14.19%) than the younger cohort. The older adult cohort had fewer postoperative pancreatic fistulas (11.33% vs 13.73%), however. Multivariate logistic regression revealed that older adult age (odds ratio 3.316) and hypertension (odds ratio 5.813) were significantly associated with increased odds of postoperative myocardial infarction.

Conclusions: We found higher rates of mortality and postoperative myocardial infarction among older adults after Whipple procedures. Regardless of this elevated risk, a higher proportion of older adult patients presented with pancreatic cancer and required the procedure.