@article{610e8bf841c04511bfa2bdc7c09f8948,
title = "Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy",
abstract = "Background: For pancreatectomy patients, mortality increases with increasing age. Our study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers. Methods: We identified 2694 patients who underwent pancreatic resection from the American College of Surgeons' National Surgical Quality Improvement Pancreatectomy Demonstration Project at 37 high-volume centers. Overall morbidity and in-hospital mortality were determined in patients younger than 80 years (N=2496) and 80 years or older (N=198). Failure to rescue was the number of deaths in patients with complications divided by the total number of patients with postoperative complications. Results: No significant differences were observed between patients younger than 80 years and those 80 years or older in the rates of overall complications (41.4%vs 39.4%, P=0.58). In-hospital mortality increased in patients 80 years or older compared to patients younger than 80 years (3.0% vs 1.1%, P=0.02). Failures to rescue rates were higher in patients 80 years or older (7.7% vs 2.7%, P=0.01). Across 37 high-volume centers, unadjusted complication rates ranged from 25.0% to 72.2% and failure to rescue rates ranged from 0.0% to 25.0%. Among patients with postoperative complications, comorbidities associated with failure to rescue were ascites, chronic obstructive pulmonary disease, and diabetes. Complications associated with failure to rescue included acute renal failure, septic shock, and postoperative pulmonary complications. Conclusions: In experienced hands, the rates of complications after pancreatectomy in patients 80 years or older compared to patients younger than 80 years were similar. However, when complications occurred, older patients were more likely to die. Interventions to identify and aggressively treat complications are necessary to decrease mortality in vulnerable older patients.",
keywords = "Complications, Failure to rescue, Mortality, Pancreatectomy",
author = "Tamirisa, {Nina P.} and Parmar, {Abhishek D.} and Vargas, {Gabriela M.} and Mehta, {Hemalkumar B.} and {Molly Kilbane}, E. and Hall, {Bruce L.} and Pitt, {Henry A.} and Riall, {Taylor S.}",
note = "Funding Information: Funding has been received for this study from Cancer Prevention Research Institute of Texas Grant RP140020, UTMB Clinical and Translational Science Award UL1TR000071, NIH T-32 Grant T32DK007639, and AHRQ Grant 1R24HS022134. B.L.H. is a paid consulting director of the ACSNSQIP. This study would not have been possible without the collaboration of the following institutions: Albany Medical Center, Baptist Memorial Healthcare-Memphis, Baylor University Hospital, Baystate Medical Center, Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham & Women''s Hospital, California Pacific Medical Center, Cleveland Clinic Hospital, Emory University Hospital, Hospital of the University of Pennsylvania, Indiana University Health-Methodist Hospital, Indiana University Health-University Hospital, Intermountain Medical Center, Johns Hopkins Hospital, Kaiser Permanente-San Francisco, Kaiser Permanente-Walnut Creek, Lehigh Valley Hospital, Massachusetts General Hospital, Mayo Clinic-Methodist Hospital, Mayo Clinic-St Mary''s Hospital, Northwestern University Hospital, Oregon Health and Science University, Penn State Milton S. Hershey Medical Center, Providence Portland Medical Center, Sacred Heart Medical Center, Stanford Hospital and Clinics, Tampa General Hospital, The Ohio State University Medical Center, Thomas Jefferson University Hospital, University of Alabama Medical Center, University of California Irvine, University of California San Diego Medical Center, University of Iowa Hospital and Clinics, University of Kentucky Chandler Medical Center, University of Texas Medical Branch, University of Virginia Medical Center University of Wisconsin Hospital and Clinics, Vanderbilt University Medical Center, Wake Forest University Baptist Medical Center, Washington University/ Barnes Jewish Hospital, and Winthrop University. Publisher Copyright: {\textcopyright} 2015 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2016",
doi = "10.1097/SLA.0000000000001093",
language = "English (US)",
volume = "263",
pages = "385--391",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",
}