Abstract Background Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD. Methods This was a multicentre retrospective case–control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates. Results In total, 235 octogenarians (median age 81 (range 80–90) years) and 235 controls (age 67 (31–79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0–3) versus 0 (0–2); P = 0.010) and Charlson Co-morbidity Index score (7 (6–11) versus 5 (2–9); P = 0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P = 0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P = 0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality. Conclusion Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians.

中文翻译：

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八旬老人胰十二指肠切除术后的短期结果：多中心病例对照研究

摘要 背景胰十二指肠切除术 (PD) 通常是针对多种病症的手术治疗方法。由于担心围手术期结果不佳，老年患者可能会被拒绝手术。本研究的目的是评估术后临床结果，并为英国目前在 PD 术后老年人群中的实践提供证据。 方法这是一项多中心回顾性病例对照研究，对象为 2008 年 1 月至 2017 年 12 月期间接受 PD 的八旬老人，并与来自英国七个专科中心的年轻对照进行匹配。主要终点是 90 天死亡率。次要终点是入院死亡率、术后并发症和 30 天再入院率。 结果该研究总共包括 235 名八旬老人（中位年龄 81（范围 80-90）岁）和 235 名对照者（年龄 67（31-79）岁）。东部肿瘤合作组表现状态（中位数 0（范围 0-3）与 0（0-2）；P = 0.010）和 Charlson 共病指数评分（7（6-11）与 5（2-9）；P = 0.001）八十多岁的人高于对照组。术后并发症和 30 天再入院率相当。八旬老人的 90 天死亡率更高（9% vs 3%；P = 0.030）。指数入院死亡率具有可比性（4% vs 2%；P = 0.160），表明死亡率差异与出院后死亡有关。尽管八旬老人的 90 天死亡率较高，但多变量 Cox 回归分析并未将年龄确定为术后死亡率的独立预测因素。 结论尽管仔细选择患者并采用可比较的入院死亡率指数，但八旬老人的 90 天死亡率，尤其是院外死亡率较高。