Risk factors of severe postoperative complications in elderly patients with pancreaticoduodenectomy

doi:10.16139/j.1007-9610.2023.02.10

Abstract

Abstract:

Objective To investigate the risk factors of severe complications of elderly patients with pancreaticoduodenectomy (PD). Methods The clinical data of 399 elderly patients with PD and 65 years or more (65-91years) including 76 cases with 75 years or more （19.0%） in this hospital from January 2016 to December 2020, were retrospectively analyzed. Less Barthel index score was used to indicate lower activities of daily living. The risk factors of severe complications after PD were analyzed by binary Logistic regression and predictive model was established. Receiver operating characteristic (ROC) curve was used to verify the predictive efficiency of model. Results A total of 224 cases were found postoperative complications from 399 elderly PD cases with the rate 56.14% including 187 (46.87%) cases of mild complications and 37 (9.27%) cases of severe complications. Age ≥75 years (OR=2.78, P<0.05), combined with hypertension (OR=4.20, P<0.05) and less Barthel index score (OR=0.96, P<0.05) were independent risk factors for severe complications after PD in elderly patients. The risk prediction model of severe postoperative complications of PD was constructed using 6 indexes including age, hypertension, preoperative nutritional risk, operative type, Barthel index score in activities of daily living and operative time, and the fit of regression equation 0.93. ROC curve analysis showed that area under curve (AUC) was 0.76, the sensiti-vity 65%, and the specificity 76%. Conclusions Age 75 years or more, hypertension and low activities of daily living would be independent risk factors for severe complications after PD in elderly patients. The risk model constructed by age, hypertension, preoperative nutritional risk, operative type, Barthel index score in activities of daily living and operative time had certain predictive efficacy for severe complications after PD in elderly patients.

Key words: Elderly, Pancreaticoduodenectomy, Severe postoperative complication, Risk factor

CLC Number:

R735.9

YU Lan, ZHANG Yongyi, HUANG Lei, WAN Xin, JIANG Shengyao, TANG Sijing, ZHANG Jun, HU Weiguo. Risk factors of severe postoperative complications in elderly patients with pancreaticoduodenectomy[J]. Journal of Surgery Concepts & Practice, 2023, 28(02): 139-146.

Figures/Tables 5

Tab 1

Characteristics of patients with or without severe complications [ x±s/n（%）/M（Q1,Q3）]

Item	Total（n=399）	Severe complication		χ²/Z/t value	P value
Item	Total（n=399）	Yes（n=37）	No（n=362）	χ²/Z/t value	P value
Gender
Male	233 (58.4)	24 (64.9)	209 (57.7)	0.70	0.40
Female	166 (41.6)	13 (35.1)	153 (42.3)
Age≥75 years	76 (19.0)	14 (37.8)	62 (17.1)	9.34	<0.001^a)
Age (years)	70.6 ± 4.7	72.7 ± 6.2	70.4 ± 4.4	2.22	0.03^a)
With diabetes	123 (30.8)	12 (32.4)	111 (30.7)	0.05	0.82
With hypertension	215 (53.9)	27 (73.0)	157 (43.4)	11.84	<0.001^a)
Domicile
Shanghai	197 (49.4)	24 (64.9)	173 (47.8)	4.14	0.24
Jiangsu	69 (17.3)	5 (13.5)	64 (17.7)
Zhejiang	56 (14.0)	4 (10.8)	52 (14.3)
Others	77 (19.3)	4 (10.8)	73 (20.2)
Barthel index score	77.8 ± 7.6	74.3 ± 14.4	78.2 ± 6.4	2.98	<0.001^a)
Operative type
Open pancreatoduodenectomy	329 (82.5)	34 (91.9)	295 (81.5)	2.51	0.11
Da Vinci robot operation	70 (17.5)	3 (8.1)	67 (18.5)
Surgical procedure
Pancreatoduodenectomy	351 (88.0)	29 (78.4)	322 (89.0)	3.55	0.06
Complex pancreatoduodenectomy	48 (12.0)	8 (21.6)	40 (11.0)
Operative time (min)	310 (265，365)	330 (290，393)	305 (261，360)	1.91	0.05
Intraoperative blood loss（mL）	400 (300，600)	500 (300，800)	400 (300，600)	1.32	0.19
Tumor location
Pancreas	311 (77.9)	30 (81.1)	281 (77.6)	0.23	0.62
Others	88 (22.1)	7 (18.9)	81 (22.4)
Pathological classification
Adenocarcinoma	337 (84.5)	33 (89.2)	304 (84.0)	0.70	0.40
Others	62 (15.5)	4 (10.8)	58 (16.0)
Preoperative nutritional risk	286 (71.7)	29 (78.4)	257 (71.0)	0.90	0.34
ALB on admission (g)	37.3 ± 5.3	36.4 ± 5.6	37.4 ± 5.3	0.89	0.37
HB on admission (g)	124.1 ± 17.8	122.0 ± 21.8	124.3 ± 17.4	0.63	0.53
Postoperative hospital stay (d)	21.8 ± 11.9	28.4 ± 15.4	21.1 ± 11.3	2.84	<0.001^a)
Total hospital stay (d)	29.2 ± 12.8	37.4 ± 16.3	28.3 ± 12.2	4.42	<0.001^a)
Cost in hospital stay (×10 000 RMB)	10.9 ± 4.5	15.1 ± 6.1	10.4 ± 4.1	4.50	<0.001^a)

Tab 1

Tab 2

Tab 3

Tab 4

Fig 1

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Variables	β	SE	Wald χ²	P value	OR（95%CI）
Interaction between surgical procedure and operative type	-0.026	0.344	0.006	0.940	0.974（0.497-1.912）
Interaction between surgical procedure and operative time	0.002	0.001	3.045	0.081	1.002（1.000-1.004）
Interaction between surgical procedure and intraoperative blood loss	0.000	0.000	0.244	0.621	1.000（0.999-1.001）
Interaction between operation type and operative time	-0.002	0.002	1.098	0.295	0.998（0.995-1.002）
Interaction between operative type and intraoperative blood loss	0.000	0.001	0.239	0.625	1.000（0.998-1.001）
Interaction between operative time and intraoperative blood loss	0.000	0.000	1.949	0.163	1.000（1.000-1.000）

Variables	OR（95%CI）	P value
Age		0.01^a
≥75 years	2.67 (1.24-5.74)
<75 years	1 (reference)
With hypertension		0.00^a
Yes	3.85 (1.74-8.53)
No	1 (reference)
Preoperative nutritional risk		0.09
Yes	2.13 (0.89-5.13)
No	1 (reference)
Operative type		0.13
Da Vinci robot operation	0.38 (0.11-1.31)
Open pancreatoduodenectomy	1 (reference)
Barthel index score	0.97 (0.94-1.00)	0.03^a)
Operative time	1.00 (1.00-1.01)	0.04^a)