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P OSTER
A BSTRACTS
status, procedure complexity, and the presence or absence of major
complications.
Results: 100,831 patients were included for analysis. In general,
advanced age was associated with increased preoperative comorbidities
and postoperative complications. After adjustment for these associations,
however, advanced patient remained an independent predictor
of overall and diagnosis-specific mortality and for
failure-to-rescue (mortality after the development of a major complication;
see Table). Of the 32 variables included for risk adjustment,
the strongest predictor of postoperative mortality for those patients
aged ≥80 years was the development of a major postoperative complication
(adjusted odds ratio 5.69, 95% CI 4.88-6.59).
Conclusions: Advanced age is an indepedendent predictor of
mortality after emergency general surgery, even after adjustment for
other known perioperative predictors. Failure-to-rescue is identified
as a primary reason for this increase in mortality. Efforts to improve
the outcomes of elderly patients needing emergent surgery should
focus on prevention of major postoperative morbidity.
B171
Age and Preoperative Geriatric Assessments in Predicting Surgical
Outcomes in a Prospective Study of Patients Undergoing
Pancreaticoduodenectomy.
J. A. Hemmerich, 1 K. K. Roggin, 2 A. M. Kamm, 2 E. Melstrom, 1
S. Wilson, 1 W. Dale. 1 1. Medicine, The University of Chicago, Chicago,
IL; 2. Surgery, The University of Chicago, Chicago, IL.
Supported By: The Michael Rolfe Foundation, Rita Meltzer, The
John A. Hartford Foundation
Drs. Hemmerich and Roggin are co-first authors.
Objective: Older patients with pancreas cancer are often not
considered for pancreaticoduodenectomy (PD) due to anticipated
perioperative complications and prolonged recovery. Pre-operative
geriatric assessment (GA) of vulnerability might better predict major
complications, readmissions, discharge site, and hospital stays. We
conducted a prospective study of GA in older patients who were undergoing
PD.
Methods: PD-eligible patients were enrolled into a single-site
prospective observational study. Preoperative GA included components
of Fried’s Model of Frailty (weight loss/weakness/self-reported
exhaustion), the Vulnerable Elder Survey (VES-13), the short physical
performance battery (SPPB). Socio-demographics, body mass
index (BMI) clinical characteristics (including co-morbidities), and
American Society of Anesthesiologist (ASA) scores were also collected
at baseline. Outcomes included graded surgical complications
(Clavien classification), length of hospital stay, discharge location
(home vs rehab) and 30-day readmissions. Linear and logistic regressions
were used to control for the influence of patient age, body mass
BMI, preoperative ASA score, and co-morbid burden.
Results: A total of n=76 had a PD (median age 68 years; range
36-88). Significant preoperative vulnerability was identified in the
sample: VES-13 >3 in 15.0%; SPPB