# Risk Evaluation of the NCD Risk Calculator for Open Pancreaticoduodenectomy in Elderly Patients: A Validation Study

## TL;DR

This study validates a risk calculator to assess surgical outcomes in elderly patients undergoing pancreaticoduodenectomy, showing it can predict poor postoperative outcomes.

## Contribution

The study validates the Japanese National Clinical Database risk calculator for predicting postoperative outcomes in elderly patients undergoing pancreaticoduodenectomy.

## Key findings

- The predicted incidence of postoperative ADL decline ≥ 44.8% and Clavien–Dindo grade IV or higher complications ≥ 9.2% were independent predictors of poor outcomes.
- 100% of patients with both risk factors had poor postoperative outcomes, compared to 15.7% with none.
- The findings were validated in a separate cohort, confirming the calculator's predictive value.

## Abstract

There is no clear indication for surgery in pancreaticoduodenectomy (PD) for the elderly patients. The aim of this study was to use real‐world data to investigate the usefulness of preoperative risk assessment with the risk calculator available in the National Clinical Database (NCD) in Japan.

A retrospective analysis of 311 patients aged ≥ 65 years who underwent PD was performed. In addition to background factors, preoperative predicted incidence rates calculated with the risk calculator, as well as visceral fat analysis items, were analyzed. Patients with (1) serious postoperative complications, (2) a decline in postoperative activities of daily living (ADL), or (3) discharge to a place other than home were defined as having a poor postoperative course. All patients were randomly assigned to the training cohort (n = 209) or validation cohort (n = 102).

Comparisons of patient characteristics revealed no differences between the training and validation cohorts. In the training cohort, multivariate analysis revealed that “Predicted incidence of postoperative ADL decline” of ≥ 44.8% (OR 4.68; p = 0.031) and “Predicted incidence of Clavien–Dindo grade IV or higher” of ≥ 9.2% (OR 5.92; p = 0.025) among those calculated with the risk calculator were independent predictors of a poor postoperative course. Among patients with 2, 1, and none of these factors, 100%, 47.4%, and 15.7%, respectively, had a poor postoperative course.

A “Predicted incidence of postoperative ADL decline” and “Predicted incidence of Clavien–Dindo grade IV or higher” in the NCD risk calculator were useful predictors of a poor postoperative course after PD.

This study investigated the utility of the Japanese NCD risk calculator for preoperative assessment in elderly patients undergoing pancreaticoduodenectomy (PD), using a validation study design. In the training cohort, two preoperative factors—the predicted incidence of postoperative ADL decline ≥ 44.8% and Clavien–Dindo grade IV or higher complications ≥ 9.2%—were identified as independent predictors of a poor postoperative course, and these findings were validated in a separate cohort. These results suggest that the NCD risk calculator is a valuable tool for stratifying surgical risk in elderly PD patients.