Analysis of Outcomes in Pancreaticoduodenectomy for Elderly Patients Aged 80 and Above: A Retrospective Study Using Inverse Probability of Treatment Weighting

TL;DR

The study finds that pancreaticoduodenectomy is generally safe for elderly patients over 80, though they face higher short-term mortality risks.

Contribution

This study uses IPTW to show that age alone does not increase complications or reduce survival after PD, but comorbidities do.

Findings

Elderly patients (≥80) had higher 90-day mortality (13.64%) compared to younger groups.

Hypertension, CAD, and poor nutrition increased complication risks in elderly PD patients.

Age ≥80 and CAD were independent risk factors for 90-day mortality.

Abstract

With an aging population, more elderly individuals are facing the decision to undergo complex surgeries, such as pancreaticoduodenectomy (PD). This study evaluates the safety and feasibility of PD in patients aged 80 and above.

We conducted a retrospective analysis of 422 patients who underwent PD between August 2011 and January 2024. The patients were categorized into three age groups: < 60 years, 60–79 years, and ≥ 80 years. We adjusted for baseline characteristics using inverse probability of treatment weighting (IPTW) and compared postoperative complications, hospital stay durations, 90‐day mortality, and long‐term survival across the groups. A subgroup analysis identified factors associated with complications and 90‐day mortality.

After IPTW adjustment, no significant differences in complications or long‐term survival were observed between the groups. However, the ≥ 80‐year group had a significantly higher 90‐day mortality rate (13.64%) compared to the 60–79 years group (2.00%) and the < 60 years group (1.46%) (p = 0.002). Subgroup analysis identified hypertension, coronary artery disease (CAD), and nutritional risk (NRS ≥ 3) as independent risk factors for complications, while age ≥ 80 and CAD were associated with higher 90‐day mortality.

Age does not significantly impact postoperative complications or long‐term survival following PD. While PD is safe and feasible for the elderly, those with cardiovascular comorbidities or poor nutritional status face higher risks of complications and mortality. A comprehensive preoperative assessment is critical to minimizing these risks.

This graphic summary shows the main clinical outcomes of patients over 80 years of age following pancreaticoduodenectomy (PD) after adjusting for propensity score weighting (IPTW). Compared with younger patients, there was no significant difference in postoperative complication rates or overall survival time in elders.

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