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Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?
Author(s) -
Neuwirth Madalyn G.,
Bierema Christine,
Sinnamon Andrew J.,
Fraker Douglas L.,
Kelz Rachel R.,
Roses Robert E.,
Karakousis Giorgos C.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30977
Subject(s) - medicine , cancer , comorbidity , pancreas , incidence (geometry) , population , pancreatic cancer , surgery , general surgery , physics , environmental health , optics
BACKGROUND Although there is a general perception that, as the older population grows in number, more are undergoing surgery, there are few data on trends in major resections for cancer and short‐term outcomes in this group. METHODS The Nationwide Inpatient Sample was (NIS) used to estimate the national trends of major upper abdominal resections (esophagus, stomach, liver, pancreas) for cancer in octogenarians (aged ≥80 years) from 2001 to 2011. Resection rates performed per year were incidence‐adjusted within this age group for each cancer type as determined by the NIS database. Joinpoint regression was used to calculate average annual percentage changes (AAPC) when evaluating trends over time. RESULTS During the study period, octogenarians underwent an estimated 30,356 upper abdominal organ resections for cancer in the United States, representing 3.8% of all cancer admissions among octogenarians. Resection rates in octogenarians increased significantly over time (AAPC, 2.54; P < .001) secondary to increasing trends in pancreatic (AAPC, 11.52; P < .001) and hepatic (AAPC, 6.67; P < .001) resections. Elixhauser comorbidity index scores increased from a mean of 3.61 to 4.20 (AAPC, 1.31; P < .001), whereas inpatient mortality during this time decreased from 13.6% to 8.2% (AAPC, 5.58; P < .001). CONCLUSIONS Overall rates of major upper abdominal cancer resections in octogenarians are increasing over time, driven by increases in liver and pancreatic resections. These increases were observed despite a less favorable patient morbidity profile over time. These patterns may suggest shifting selection criteria for octogenarians undergoing major abdominal surgery over time in the context of diminishing postoperative mortality. Cancer 2018;124:125‐35 . © 2017 American Cancer Society .