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The Impact Of Age On Elective Proctectomy Outcomes In Elderly Patients
*Katherine Y Hu, *Ruizhe Wu, *Aniko Szabo, Timothy J Ridolfi, Kirk A Ludwig, *Carrie Y Peterson
Medical College of Wisconsin, Milwaukee, WI

OBJECTIVE(S):
As the US population ages, more elderly patients will require colorectal surgery. These patients are frailer, have more comorbidities, and are thought to be at higher risk for poor outcomes. However, many studies evaluating the impact of age utilize older data, and may not reflect improvements in surgical technology and patient care. The objectives of this study were to evaluate the impact of age on postoperative outcomes in geriatric patients undergoing elective rectal surgery, using updated data from a national cohort.
METHODS:
The ACS-NSQIP procedure-targeted data files were used to identify patients age 65-89 who underwent elective proctectomy procedures in 2016-2017. Baseline patient characteristics, intraoperative data, and post-operative outcomes were collected. Patients were stratified into three age groups: 65-69, 70-79, and 80-89. The association between age and outcomes were assessed using Chi-square, ANOVA, and Kruskal-Wallis tests. Logistic regression was performed using morbidity and mortality as outcomes of interest, and potential interaction of variables with age-group were evaluated.
RESULTS:
Of 2506 patients meeting inclusion criteria, 855(34.1%) were age 65-69, 1123(44.8%) were 70-79, and 528(21.0%) were 80-89. Patients age 80-89 were significantly less likely to undergo a minimally invasive approach (32.3% vs 46.3%, p<0.01) compared to those age 65-69. The most common complications were need for blood transfusion (11.4%) and organ-space SSI (5.4%). Overall 30-day mortality was low, at 0.7%. Logistic regression analysis showed that compared to patients age 65-69, there was no difference in odds of combined 30-day morbidity for patients age 70-79, and decreased morbidity in patients aged 80-89 (OR 0.70, p=0.01). Preoperative risk factors associated with increased morbidity included baseline dyspnea, diabetes, smoking, disseminated cancer, and anemia. In further age-interaction analyses, older age did not have a significant effect on the risk associated with these preoperative variables.
CONCLUSIONS:
In this study of geriatric patients, increased age was not significantly associated with worse 30-day postoperative outcomes and had minimal impact on the effect of preoperative risk factors. Although likely affected by selection bias, our results demonstrate that with careful patient selection, even the oldest patients can do well after proctectomy. Age alone should not be a contraindication to surgery.


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