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

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Southern Medical Journal Pub Date : 2025-03-01 DOI:10.14423/SMJ.0000000000001800

Daniel Hakakian, Allison J Bellaire, Jana K Elsawwah, Lawrence E Harrison, Rolando H Rolandelli, Zoltan H Nemeth

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引用次数: 0

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.

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老年患者惠普尔手术的危险因素和手术结果。

目的：Whipple手术，或胰十二指肠切除术合并胰空肠吻合术，可能导致生理储备较低的老年成年患者的不良后果。因此，我们研究了老年人和年轻人（非老年人）在惠普尔手术后合并症和术后结果的差异。方法：我们使用2021年美国外科医师学会国家手术质量改进计划数据库，比较1553名老年人（70岁及以上）和2171名年轻成人（18-69岁）接受惠普尔手术的临床因素。结果：老年人群的癌症诊断率（58.02%比50.99%）、糖尿病（31.49%比26.07%）、充血性心力衰竭（2.38%比1.29%）、高血压（67.80%比44.13%）和美国麻醉医师协会≥3级（89.83%比80.01%）较高。老年队列的术后死亡率（1.35% vs 0.69）、肺炎（3.73% vs 2.12%）、输血（20.15% vs 17.00%）和胃排空延迟（16.61% vs 14.19%）也高于年轻队列。然而，老年组的术后胰瘘较少（11.33% vs 13.73%）。多因素logistic回归分析显示，年龄较大（优势比3.316）和高血压（优势比5.813）与术后心肌梗死发生率增加显著相关。结论：我们发现老年人在惠普尔手术后死亡率和术后心肌梗死发生率较高。尽管风险升高，但更高比例的老年胰腺癌患者需要进行手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Southern Medical Journal 医学-医学：内科

CiteScore

1.40

自引率

9.10%

发文量

222

审稿时长

4-8 weeks

期刊介绍： As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.