Major cancer surgery in the elderly: Results from the american college of surgeons national surgical quality improvement program

Objective: To examine the association between older age and short-term outcomes after major oncologic resections. Summary Background Data: The effect of older age on outcomes from major cancer surgery remains conflicting because of limitations in measuring coexisting comorbidities. Given the critical role of surgery, older patients and their surgeons often question decisions regarding major cancer surgery. Methods: We identified 8781 patients who underwent elective or emergent major thoracic, abdominal, or pelvic resections for neoplasms in the 2005 to 2007 American College of Surgeons National Surgical Quality Improvement Program database. Pre, intra-, and postoperative characteristics were compared by age groups. Multivariable techniques were used to predict adjusted short-term operative outcomes. Results: Older patients were more likely to have preoperative comorbidities and to receive intraoperative blood transfusions, but at the same time have shorter operative times. Increased age was also associated with higher operative mortality (4.83% for >75 years vs. 1.09% for ages 40-55 years), a greater frequency of major complications, and more prolonged hospital stays-all of which persisted after multivariable adjustments. Despite its strong association with 30-day operative mortality, the impact of older age was comparable to other preoperative risk-factors predictive of short-term operative outcomes. Conclusions: The present study, which is one of the largest multihospital studies, showed that older age is independently associated with worse short-term outcomes after major oncologic resections. However, the effect of age was not prohibitively worse, and is comparable to the effects of other preoperative risk factors. These findings support the use of risk-based treatment decision-making in older patients.