The risk of postoperative complications following pancreaticoduodenectomy is thought to be higher in octogenarians than in younger patients. Despite higher complication rates, the costs of pancreaticoduodenectomy in this population are thought to be similar. We conducted a retrospective chart review of patients undergoing pancreaticoduodenectomy at a single institution from 2009 to 2014. Patient demographics, operative details and post- operative complications were obtained from patients’ charts. Hospitalization and emergency department costs up to 90 days following surgery were obtained from hospital administrative databases. Risk factors associated with postoperative complications were analyzed using univariable and multivariable analyses. There were 276 patients included, and they were divided into 2 age groups: 253 younger patients (< 80 years, median age 65 years) and 23 octogenarians (≥ 80 years, median age 82 years). Pancreatic cancer was the most common indication for surgery (58% v. 65%). The mean American Society of Anesthesiologists (ASA) class was higher in the octogenarian group (3.2 v. 3.4, p = 0.026). The length of hospital stay was longer in this group also (9 v. 11 days, p = 0.042). The overall postoperative complication rate (47% v. 74%, p = 0.015) and the major complication rate (18% v. 39%, p = 0.016) were higher in the octogenarian group, mainly due to a higher rate of pneumonia (5% v. 22%, p = 0.011). The re-hospitalization rate and the postoperative mortality were not statistically different between groups. In the multivariable analysis, factors associated with major complications were age greater than 80 years (OR 3.2, 95% CI 2.27–4.13) and a diagnosis other than pancreatic cancer (OR 2.65, 95% CI 2.02–3.27). There was a trend for a higher overall mean cost in the octogenarian group, $32 616 ± $32 616 v. $34 649 ± $42 340 mainly driven by a higher cost of primary surgery: $28 053 ± $23 241 v. $33 271 ± $42 559. Pancreaticoduodenectomy in octogenarians is associated with higher rates of overall and major postoperative complications, which lead to a longer length of hospital stay and higher costs for the health care system.

Surgical outcomes and costs of pancreaticoduodenectomy in octogenarians.