Comprehensive Perioperative Geriatric Assessments May Predict Surgical Outcomes in a Prospective Study of Older Patients Undergoing Pancreaticoduodenectomy

Abstract

Introduction: Older patients with pancreatic cancer are often not offered pancreaticoduodenectomy (PD) due to potentially high perioperative risk and prolonged post-operative recovery. These patients may have undetected vulnerabilitities related to frailty that may adversely affect surgical outcomes. Methods: PD-eligible patient over 50 were enrolled onto this IRB-approved prospective observational study. Extensive perioperative clinical information including Vulnerable Elder Survey (VES-13), short physical performance battery (SPPB), and Fried's Criteria for frailty were collected. Complications were prospectively recorded and graded according to established guidelines (Clavien scores). Quality of life (QoL) measures were taken at baseline and at 1, 3, and 6-months post-PD. Results: Seventyeight patients were enrolled from 10/1/2007-9/1/2010: 53 had a PD (median age 68 years;range 46-85) and 25 were inoperable or declined PD. Significant preoperative vulnerability was identified in resected patients; VES-13 >3 in 24%; SPPB <10 in 49%; Fried's exhaustion in 40%. The perioperative morbidity rate was 70% and three patients died (8.6%). Twenty-three patients (43%) had severe complications (Clavien grade≥ III). Abnormal VES13 showed predictive promise for post-operative admission to the SICU rs(53)=.34, p<.05, longer SICU stays rs(53)=.42, p<.01, and total hospital days rs(53)=.26, p=.09. Self-reported exhaustion predicted complications and post-operative admission to the SICU, χ2(1, N = 53) = 4.1, p<.05. Older age was predictive of not being discharged to home rs(53)= -.35, p<.05 and perioperative death, rs(53)=.31, p<.05. 22 patients have complete QoL data that shows a wide variance at baseline, a significant drop-off at 1 month and return to baseline by 6 months. Conclusion: We identified significant vulnerability in older patients undergoing PD. Early analyses suggest that comprehensive perioperative geriatric measures can predict post-surgical outcomes. If sought for and identified, these issues could be managed expectantly, leading to more accurate preoperative counseling and in-hospital care.