Octogenarian Group Research Articles

PP45 - Octogenarians – A growing population in cardiac surgery

Octogenarians are a growing population of patients who are candidates for cardiac surgery. The author analyses a single centre experience with patients over 80 years of age who underwent cardiac surgery. A retrospective observational study was performed at the University Hospital in the period from 2011 to 2015. During that period 2139 heart operations were performed; authors compared preoperative, intraoperative and postoperative data of 1890 patients younger than 80 with group of octogenarian (123 patients over 80 years underwent cardiac procedures). There where 123 (6%) patients 80 years old or older. Sixty-five percent (65%) of the procedures were elective, 29% emergency and 6% urgent. Coronary artery bypass grafting was performed in 37% of patients, aortic valve replacement surgery in 31%, interventions involving the mitral valve in 3%, two procedures (CABG+AVR, CABG+MVR or AVR+MVR) in 22% and other procedures in 6%. The mean age of the patients was 81 (80-88 range). Octogenarian had a statistically higher Euroscore (p<0,001), more COPD (p<0,05), diabetes mellitus type 2 (p<0,05) and malignancies (p<0,01). There was no statistical difference in the operation time, CPB time and clamp time. Postoperative (cumulative) time in ICU was higher in octogenarian group (p<0,01); ventilator time was longer (p<0,01) there were more respiratory complications (p<0,01) and tracheotomies (p<0,05). Octogenarian received more transfusions. (p<0,01). Although their physical status was heavily burdened with preoperative comorbidities (8 patients had a cerebrovascular insult (7%), 16 (13%) some kind of vascular surgery, 10 (8%) COPD, 34 (28%) atrial fibrillation, 28 (23%) myocardial infarction, 96 (78%) hypertension, 29 (24%) diabetes, 24 (20%), various degrees of renal insufficiency, 2 patients (1.63%) were on haemodialysis, mortality was low- one patient died (0,8%). Octogenarians are a growing population of patients undergoing cardiac surgery. These patients often present multiple comorbidities that put them in a higher risk category. However, improvements in surgical technique, CPB technology and perioperative management enable us to perform cardiac surgery procedures in a safe manner.

Esophagectomy for cancer in octogenarians: should we do it?

Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer. A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79years. A case-matched group of patients younger than 80years old (n=33) was included based on the Charlson comorbidity index with the octogenarian group (n=33). Endpoints included operative morbidity and mortality as well as short- and long-term survival. Thirty-three octogenarians met inclusion criteria. The median age was 82years, and 79% were male; 76% had adenocarcinoma, 87% had distal esophageal, and 52% had poorly differentiated tumors. Stages 0 through III were observed in 6, 18, 27, and 48% of octogenarians, respectively. Neoadjuvant therapy was administered to 70% of patients, with 48% experiencing downstaging. Transhiatal esophagectomy was performed in 82% of patients, with R0 resection in 94%. The mean hospital stay was 18days, with morbidity and mortality rates 56 and 9%, respectively, not significantly different from 13-day hospital stay, 45% morbidity, and 9% mortality in younger patients. Cardiac, pulmonary, and surgical site complications occurred in 24, 27, and 6% of octogenarians, respectively. Anastomotic leak occurred in 18% and reoperations in 3%. The median, 3-year survival, and 5-year survival were 21months, 55.9%, and 37.1%, respectively. Overall survival was worse for octogenarians (p<0.001). Postoperative mortality, morbidity, and length of stay in octogenarians are comparable to younger patients, while the overall survival is worse. With appropriate patient selection, good outcomes can be accomplished in octogenarians undergoing esophagectomy for cancer.

Mortalidad de la cirugía coronaria aislada en octogenarios. Análisis restrospectivo de 14 años

IntroductionWe aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup. Material and methodFrom January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed. ResultsWe identified 99 patients older than 80 years (80-group; mean age 82±3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2±9.7 years). Additive EuroSCORE was 8.4±4.8 and 4.6±4.6 (P<.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (P<.001) in the 80-group vs. the control group. respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (P<.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; P=.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; P=.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6-19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1-12.2). The mean follow-up was 6.3±4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period. ConclusionCoronary artery bypass graft is performed preferably in patients over 80 years old under the off-pump procedure. Mortality is higher in this group of patients probably related to a higher incidence of cardiovascular complications and reintervention for bleeding in the immediate postoperative period.

Perioperative and long-term outcomes in octogenarians after kidney transplantation: theUS perspective .

We aimed to study outcomes on octogenarian patients undergoing kidney transplantation in the US. We queried the UNOS dataset from 1988 through 2013 and found 471 octogenarians transplanted during the study period. 86 (18.3%) were female and 385 (81.7%) were male with a mean age of 81.58 years. The octogenarians had a significantly higher incidence of diabetes, at 17.2% compared to 13.7% in the non-octogenarian group (p <0.001). The mean donor age was 50.32 years in the octogenarian group vs. 38.02 years in the younger group (p<0.001). The cold ischemic time of the octogenarian group was 16.72 hours vs. 14.29 hours in non-octogenarians (p<0.001). Length of stay (LOS) was increased by 1 day in the octogenarians. We demonstrated that patients with age ≥80 have a 2.2-fold increased risk of perioperative death. The Cox analysis demonstrated that octogenarians have a 3.2-fold and 84% increased risk of graft failure and decreased survival, respectively. Octogenarians have significantly increased LOS, perioperative mortality, and rates of graft loss. Age older than 80 was an independent risk factor associated with decreased patient survival. Future studies should address differences in outcomes and quality of life of octogenarians on dialysis compared to those after kidney transplantation. .

Cementless Total Hip Arthroplasty in Octogenarians

BackgroundAlthough several studies indicate excellent results for cementless implants, controversy persists regarding its use in elderly patients. We determined to evaluate the outcome on patients aged over 80 years who were treated with cementless total hip arthroplasty for primary osteoarthritis of the hip. MethodsWe assessed the data of 162 consecutive total hip arthroplasties in octogenarian patients (mean age 83 years, range 80-96 years). A control group was created, consisting of 342 patients aged younger than 80 years (mean age 65 years, range 37-79 years). The median follow-up of the cohort was 128.4 months (range 6-211). ResultsCompeting risk analyses revealed a cumulative implant survival of 98.1% at 5 and 10 years in the study group compared to 99.1% and 98.4% in the control group, taking system exchange as the end point. No differences in regard to system exchange could be detected between the groups. A significantly worsened complication-free survival rate was evident in the octogenarian group. Osteoporosis was the most powerful risk factor that proved to have a significant negative impact on development of complications. ConclusionUncemented total hip arthroplasty is a viable option for the elderly patient. In this population sector, an excellent rate of implant survival can be expected. However, a significant increase of total complications in the octogenarian group could be detected, and was mainly caused by an elevated number of early postoperative complications. Osteoporosis turned out to be a strong risk factor in regard to complication-free survival. Surgeons should therefore be aware of this.

Clinical characteristics and outcomes of octogenarians presenting with ST elevation myocardial infarction in the Australian population.

AIMTo investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction (STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention (PCI) compared to those managed conservatively.METHODSWe performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included. The subsequent non-octogenarian patient who presented with a STEMI following the octogenarian patient was assigned to the control group in a 1:1 manner. The outcomes measured were peri-procedural cardiac arrest, death on table, cerebrovascular accidents (CVA), in-hospital and 30-d mortality.RESULTSA total of 146 patients were analyzed. The octogenarian group had a higher percentage of females, higher overall comorbidities, higher Charlson Comorbidity Index score, worse renal function and were more likely to require residential care and home help. The octogenarian group were also less likely to have PCI attempted and had a longer symptom onset to PCI time. Mortality rate was high amongst octogenarians who presented with STEMI. However, those managed conservatively had a higher in-hospital and 30-d mortality rateCONCLUSIONOctogenarians who presented with STEMI that were managed conservatively had a higher mortality rate compared to those who had primary PCI. Therefore, we propose that revascularization may be beneficial to patients in this age group.

Ischemic Stroke in the Elderly: Septuagenarians Versus Octogenarians.

Stroke prevalence is known to increase with age. Approximately 50% of acute ischemic stroke patients are aged between 70 and 89 years. In this study, records of 770 ischemic stroke patients who were 70-89 years old were retrospectively examined (407 septuagenarians and 363 octogenarians). The demographics, comorbid conditions, ischemic stroke type, and stroke outcome for the two age groups were analyzed. Comorbid hypertension, diabetes mellitus, and HbA1c levels of ≥6.5% more frequently occurred in septuagenarians than in octogenarians (80.6% versus 70.8%, p=0.002; 32.2% versus 21.8%, p=0.001; and 35% versus 23.2%, p=0.003, respectively), whereas atrial fibrillation was significantly higher in octogenarians (49.3% versus 41.5%, p=0.03). Hypercholesterolemia, previous stroke history, and antiaggregant and/or anticoagulant use were not significantly different between the two age groups. Based on the Oxfordshire Community Stroke Project classification, the most common stroke subtype in the septuagenarian group was a lacunar infarction and in the octogenarian group, it was a partial anterior circulation infarct. According to the Modified Ranking Score, the number of patients living independently was higher for septuagenarians (42.8% versus 27.8%, p<0.001). The present findings indicate that the clinical characteristics of ischemic stroke differed between septuagenarians and octogenarians. Therefore, elderly stroke patients cannot be accepted as a homogeneous group. Because this is a hospital-based study, our findings need to be tested via additional epidemiological studies.

Morbidity and mortality of colorectal cancer surgery in octogenarians

The aim of this study was to determine common problems, preoperative assessment criteria, and postoperative morbidity and mortality of octogenarians with colorectal cancer. We screened the medical records of patients aged 80 years or older (study group) and that of patients of 50–59 years of age (control group) who were operated for colon cancer. Demographic features, comorbidities, American Society of Anaesthesiologists (ASA) score, urgency of operation, tumor localization, presence of colostomy, duration of hospital stay, admission to and duration of stay in the intensive care unit (ICU), TNM (Tumor, Node, Metastasis) stage, postoperative morbidity, and mortality rates were recorded. The medical records of 23 patients aged above 80 years and 39 patients aged between 50–59 years were screened retrospectively. The two groups did not differ significantly with respect to the morbidity rate but the mortality rate was significantly higher in the study group (p = 0.583 and p = 0.016, respectively). The study group patients needed significantly more ostomy creation procedures. In the analysis of the octogenarian groups, the ASA score or the presence of comorbidities had no discernible effect on the morbidity and mortality rates. Specific preoperative evaluations are needed for prediction of mortality risk in geriatric patients. Rational criteria for performing protective ostomy should also be determined in octogenarians.

Cementless Tapered Femoral Stems for Total Hip Arthroplasty in Octogenarians

BackgroundThe use of cementless femoral components has become the standard in younger patients due to increased implant survivorship and decreased loosening. However, it remains controversial whether these femoral stems can provide comparable results in elderly patients. Therefore, our purpose was to compare the (1) incidence of revisions; (2) clinical outcomes; (3) incidence of postoperative blood transfusions; and (4) differences in complications between the 2 cohorts. MethodsSeventy-four consecutive patients (78 hips) aged 80 years or older, who underwent primary total hip arthroplasty using a cementless, tapered, femoral stem were retrospectively compared with a matched cohort of 76 patients (78 hips) who were less than 80 years. Mean age was 83 years (range, 80-91 years) vs 59 years (range, 17-79 years) for the matched group. Minimum follow-up was 2 years. Revision rates, clinical outcomes using the Harris Hip Score, incidences of complications, and postoperative transfusion rates were evaluated. ResultsIn the octogenarian cohort, the aseptic survivorship was 99%, compared with 95% in the matched group. There were 2 aseptic loosenings (2.6%): 1 femoral implant loosening (1.3%) and 1 acetabular loosening, but only 1 revision was performed, as one of the patients declined revision surgery. In the matched cohort, there were 6 revisions (7.7%). There were no significant differences in revision rates between the 2 cohorts, and no significant differences in final Harris Hip Score scores. The incidence of blood transfusion in the study group was 42% vs 19% in control group (P < .01). ConclusionThe use of cementless, tapered, femoral stems yielded excellent results in the octogenarian group, although adequate patient preoperative optimization is necessary given the significantly higher transfusion incidence.

Is a surgical approach justified for octogenarians with pancreatic carcinoma? Projecting surgical decision making for octogenarian patients

BackgroundIn recent years, more elderly patients have undergone surgery for pancreatic cancer, although the safety and efficacy of performing complex pancreatic resections in patients older than 80 years remain controversial. MethodsPatients with pancreatic cancer who underwent curative surgical treatment were divided into 2 subgroups: the younger group (<80 years) and the octogenarian group (≥80 years). ResultsFrom March 2005 to December 2013, 194 consecutive surgically curable patients with diagnosed pancreatic cancer were studied, among which 34 (17.5%) were of 80 years or older. There were no significant differences in postoperative severe complication rates for younger and octogenarian groups (16% vs 20%, respectively) or perioperative mortality rates (1.3% vs .0%). The incidence of postoperative delirium in the octogenarian group was greater than that in the younger group (23.5% vs 3.8%). ConclusionsOctogenarian pancreatic cancer patients should not be denied a priori the opportunity for surgery, particularly if the patient represents an ideal candidate and if the co-operation of the family can be obtained.

Predictors of in-hospital mortality in octogenarian patients who underwent primary percutaneous coronary intervention after ST segment elevated myocardial infarction.

Octogenarian patients have higher mortality and morbidity rates after acute coronary syndromes. Risk factors for in-hospital mortality in the primary percutaneous coronary intervention (PCI) era were underrepresented in previous studies. In the present study, we aimed to assess the risk factors of in-hospital mortality after primary PCI in this population. We analyzed 2353 patients who underwent primary PCI after ST segment elevated myocardial infarction (STEMI). Patients were divided into two groups according to aged: ≥80 years (octogenarian) and <80 years (control). Risk factors for in-hospital mortality were analyzed in the whole group and octogenarian patients. We found that octogenarians have 10.6-fold higher mortality risk after STEMI. After a univariate and multivariate analysis, acute stent thrombosis was the most explicit risk factor for in-hospital mortality in the octogenarian group (OR 21.13, 95% CI 2.11-102.76, P < 0.001). Additionally, anterior myocardial infarction (OR 4.90, 95% CI 1.90-22.10, P = 0.04), ventricular arrhythmias (OR 15.64, 95% CI 2.81-87.12, P = 0.002), multivessel disease (OR 6.5, 95% CI 1.11-38.85, P = 0.04), ejection fraction <30% (OR 1.24, 95% CI 0.26-6.00, P = 0.04) and KILLIP score ≥2 (OR 1.20, 95% CI 0.20- 7.41, P = 0.01) were also significantly associated with mortality. Acute stent thrombosis, anterior MI, heart failure, low ejection fraction, ventricular arrhythmias and multivessel disease are the independent risk factors for in-hospital mortality among octogenarian patients after primary PCI. Geriatr Gerontol Int 2017; 17: 584-590.

Outcome of octogenarian versus (vs) young patients (pts) with metastatic renal cell carcinoma (mRCC), treated with sunitinib (su).

538 Background: Su is a standard treatment (tx) for mRCC. Octogenarian pts (aged ≥ 80) are often considered to be unfit for su tx, and recommendations for their tx is limited by the paucity of clinical trials data in this population. We aimed to study baseline characteristics and outcome of octogenarian vs young (aged ≤45) pts with mRCC treated with su. Methods: We performed an international multicenter retrospective study of pts with mRCC, who were treated with su in 8 centers across 2 different countries. We compared baseline characteristics and outcome of octogenarian versus young pts. The effect of very old age on response rate (RR), progression free survival (PFS) and overall survival (OS), was tested with adjustment of other known confounding risk factors using a chi-square test and partial likelihood test from cox model. Furthermore, univariate and multivariate analyses of association between clinicopathologic factors and age, and outcome were performed using the entire pt cohort. Results: Between 2004-2013, 36 octogenarian (group 1; median age 83) and 37 young (group 2; median age 42) mRCC were treated with su. The groups were balanced regarding the following baseline clinicopathologic characteristics: gender, HENG risk, past nephrectomy, mRCC histology, ≥ 2 metastatic sites, lung/liver/bone metastasis, prior targeted tx, smoking status, use of angiotensin system inhibitors (ASIs), pre-tx neutrophil to lymphocyte ratio (NLR) &gt;3, and sunitinib induced hypertension (HTN). In group 1 vs 2, 53% vs 27% (p=0.006) had dose reduction/treatment interruption d/t side effects. Clinical benefit (partial response + stable disease) in group 1 vs 2 was 76% vs 84%, while 24% vs 16% had disease progression within the first 3 months of tx (p=0.09). Median PFS was 11 vs 8 months (p=0.1). Median OS was 22 vs 20 months (p=0.7). In multivariate analyses of the entire pt cohort (n=73), age was not significantly associated with PFS or OS. Conclusions: Su is active in octogenarian mRCC pts. Vs young pts, a significantly higher proportion of octogenarian pts had dose reduction/treatment interruption d/t side effects.

PTU-191 Laparoscopic major colonic resections in 80+ age group; is there more to talk about?

<h3>Introduction</h3> With increasing life expectancy in the general population and changing attitudes to the provision of healthcare, an increasing number of octogenarians are offered surgical interventions. Recent advances in laparoscopic surgery and enhanced recovery protocols have enabled surgeons to offer colonic and rectal resection to the premorbid older patients more safely. The aim of this retrospective analysis is to determine the outcome and safety of performing colonic resections in the 80+ age group. <h3>Method</h3> A retrospective analysis was carried out using Electronic notes, patient case notes and Web-V system for pathology for all the patients aged 80 or above, who underwent major colorectal surgery. The Clavien-Dindo classification was used to analyse surgical complications. <h3>Results</h3> In total, 160 colonic resections were done by a single surgeon between May 2011–Jan 2015. 31 of these were aged 80 and above and were analysed further. The male to female ratio was 13:18, median age was 83, and the median duration of stay was 13 days. Median ASA grade was III. Out of these, 6 had (19.4%) anterior resections, 14 (45.2%) had right hemi-colectomy, 3 (9.7%) had left and sigmoid colectomy; 4 (12.9%) had Hartmann’s resection and 4 (12.9%) had APER. 96.7% of the 31 resections were laparoscopic, with the only exception being a resection for recurrent colonic cancer. 10 patients (32.2%) had a permanent stoma, with 1 patient being given a temporary stoma which was subsequently reversed. Cancer classification for these cases were 19.4% (n = 6) Dukes’ A, 45.2% (n = 14) Dukes’ B and 29% (n = 9) Dukes’ C. Analysis of surgical complications showed that 58% (n = 18) had normal course of recovery, 29% (n = 9) had Grade I and II complications, 2 patients had Grade III, and 2 patients had Grades IV and V complications. The patients with Grades IV and V, both suffered anastomotic leaks and were taken back to theatre; and subsequently died of multi-organ failure and sepsis. Five patients required post-operative blood transfusion. Pertinent to note in the total group of 160 resections, there were 4 anastomotic leaks and the two cases in the below 80 age group were managed with laparoscopic washout, with one case requiring a de-functioning stoma. <h3>Conclusion</h3> Laparoscopic colonic resections can be safely performed in octogenarian group with none to moderate post op complications, however their ability to withstand a major post-op complications such as anastomotic leak is poor as evident by two deaths in the group. This risk should be discussed in greater depth during the informed consent process, and should there be any doubt, it should be worth considering a permanent stoma. <h3>Disclosure of interest</h3> None Declared.

0374: Safety and effectiveness of transvenous lead extraction in octogenarians

Safety and effectiveness of transvenous lead extraction in octogenarians As the median population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase. The safety and effectiveness of lead extraction in elderly patients has not been well evaluated. We report the safety and effectiveness of transvenous lead extraction in octogenarians. From January 2002 to December 2013, we reviewed data from consecutive patients more than 80 years referred to our institution for transvenouslead extraction for infection or lead dysfonction. Clinical characteristics, procedural features, and periprocedural major and minor complications were compared between octogenarians and younger patients. Out of 391 patients undergoing lead extraction during the study period, 100 (25,6%) patients were octogenarians (mean age 84,24 years; range 80-98; 75 % males). A significantly higher percentage of octogenarians presented with chronic renal failure (P=0,03), history of malignancy (P =0,04) Infection was the most common reason for lead extraction in elderly (82% of cases).Laser assistance for extraction was recquired in 69 elderly patients (69%) Complete lead extraction efficacy were similar between both groups (99% in octogenarians vs 98,6% in patients <80 years; P =0,6). No deaths occurred in the octogenarian group. No differences in terms of other periprocedural major and minor complications were found between the 2 groups. Despite a significantly higher rate of comorbidities, transvenouslead extraction can be performed safely and successfully in octogenarians with a low rate of complications

Postoperative gastrectomy outcomes in octogenarians with gastric cancer

It is controversial whether the treatment strategy for gastric cancer should be different for elderly patients. We herein evaluated the feasibility of gastrectomy and the risk factors for postoperative complications in octogenarians with gastric cancer. We retrospectively collected data on 441 consecutive patients who underwent total or subtotal gastrectomy for gastric cancer. We divided all of the patients into two groups: the octogenarian group (n = 47), consisting of patients aged 80-89 years, and the younger group (n = 394), consisting of patients under 80 years of age. The postoperative complication rate was 23.1% (91/394) in the younger group and 36.2% (17/47) in the octogenarian group (P = 0.049). Octogenarian patients had significantly lower preoperative serum albumin levels (P < 0.001) and higher ASA scores (P < 0.001). Although the rate of each major complication was similar between the two groups, there was a trend toward a higher rate of other miscellaneous complications, mostly non-surgical complications, in the octogenarian group (P = 0.077). A multivariate analysis of the patients in the octogenarian group revealed that only total gastrectomy was a significant risk factor for postoperative complications (P = 0.035). Octogenarian patients with gastric cancer experienced more complications than younger patients. Therefore, closer monitoring is needed for octogenarian patients who will receive total gastrectomy.

Cholecystectomy in octogenarians: be careful.

Cholecystectomy is the standard treatment for symptomatic gallstone or acute cholecystitis, and a growing number of elderly patients are undergoing resection. The aim of this study is to evaluate the clinical outcome of cholecystectomy in elderly patients. We retrospectively reviewed the medical records of 337 patients with symptomatic gallstone or acute cholecystitis who underwent cholecystectomies between January 2011 and June 2013. Perioperative data were compared between octogenarians and younger patients. A subgroup undergoing cholecystectomy for acute cholecystitis (n = 146, 43.3 %) was further analyzed. The octogenarian group included 34 patients (10.1 %), while the younger patient group included 303 patients (89.9 %). The octogenarian group was associated with higher rates of comorbidities and acute cholecystitis. The octogenarian group had significantly low laparoscopic completed rates, high postoperative complication rates, and longer postoperative hospital stays. Among the acute cholecystitis group, 24 patients (16.4 %) were octogenarians and 122 patients (83.6 %) were younger patients. No significant difference was found in the morbidity and postoperative hospital stay between the two groups. Only one patient (0.3 %), an octogenarian, died of pneumonia. Cholecystectomy for symptomatic gallstone or acute cholecystitis can be safely performed even in octogenarians. However, care should be taken because they have comorbidities and limited functional reserves.

Surgical quality data and survival after pancreatic cancer resections: a comparison of results for octogenarians and younger patients.

Although age is no contraindication for pancreatic cancer resections, there are conflicting reports of morbidity and mortality rates and only few data showing direct comparisons of survival for octogenarians and patients younger than 80 years. Comparison of complication, reintervention, reoperation, and 30-day in-hospital mortality rates, length of stay, and survival of all octogenarians and patients younger than 80 years undergoing pancreatectomy for ductal adenocarcinoma during the study period from 2001 to 2010 was done. All resectable patients with suspected ductal adenocarcinoma who deemed to be fit for surgery in an interdisciplinary assessment (anesthesiology, gastroenterology, oncology, surgery) were offered pancreatectomy. The only exceptions were Eastern Cooperative Oncology Group (ECOG) performance score 3 and 4 or advanced dementia patients. Resectability was determined according to contrast-enhanced computed tomography scans (pancreas protocol). The database was prospectively maintained. For survival analysis, a first follow-up was made on December 31, 2010, by a query of the national register of residents with retrieval of corresponding International Classification of Diseases (ICD) death diagnoses by the Austrian Institute of Statistics. For surviving octogenarians, a second follow-up was made by telephone interview on August 21, 2013. We identified 9 octogenarians and 99 patients younger than 80 years. Median age in the two groups was 83 and 67 years, respectively. The predominant procedure in both groups was pylorus-preserving pancreaticoduodenectomy (55.6 and 68.7 %, respectively). Complications occurred in 33.3 and 28.3 % of patients, respectively. Reintervention, reoperation, and 30-day in-hospital mortality rates of patients younger than 80 years were 9.1, 6.1, and 5.1 %, respectively. In the octogenarian group, there were no pancreatic fistulas, one transient ischemic attack after stenting of an intraoperatively detected stenosis of the celiac trunk, one infected hematoma that was managed with intravenous antibiotics, and one wound infection. There were no reoperations or postoperative reinterventions. Median length of stay was 18 days, and postoperative 30-day mortality was nil. Median survival was comparable for both age-groups (10.5 vs. 12.1 months, respectively). In an interdisciplinary setting, surgical quality data and survival after pancreatic cancer resections are comparable in octogenarians and patients younger than 80 years.

The safety of deep hypothermic circulatory arrest in aortic valve replacement with unclampable aorta in non-octogenarians.

Aortic valve replacement (AVR) in patients with severely atherosclerotic aortas (porcelain aorta) presents a significant technical challenge. Two strategies are deep hypothermic circulatory arrest (DHCA) during conventional surgery and transcatheter aortic valve replacement (TAVR). The aim of this study was to examine the outcomes in patients who underwent DHCA for AVR with a porcelain aorta to identify whether older patients are more suitable for TAVR. Between October 2004 and December 2012, 122 patients underwent AVR using DHCA for atherosclerotic aorta. Patients with concomitant valve surgery were excluded. Overall, 63.9% (78/122) were of age <80 (non-octogenarian group, NOG) and 36.1% (44/122) were >80 (octogenarian group, OG). Of the total cohort, 62.3% (76/122) had concomitant coronary artery bypass graft surgery. The mean age for the whole cohort was 75.7 ± 8.5 years; 70.2 ± 8.1 years for the NOG and 83.4 ± 2.6 years for the OG (P = 0.001). The OG had a higher rate of preoperative renal failure (20.5%, 9/44 vs 7.7%, 6/78, P = 0.048) and trends towards a greater history of cerebrovascular disease (9.1%, 4/44 vs 1.3%, 1/78, P = 0.056), but fewer reoperations (6.8%, 3/44 vs 19.2%, 15/78, P = 0.069). Cardiopulmonary bypass time, aortic cross-clamp time and circulatory arrest time were similar between the two groups. Postoperative complication rates were similar except for permanent stroke (OG 18.2%, 8/44 vs NOG 6.4%, 5/78, P = 0.065). The overall operative mortality rate was 8.2% (10/122); however, the OG had significantly higher operative mortality compared with the NOG (15.9%, 7/44 vs 3.8%, 3/78, P = 0.035). One- and 5-year survival rates were 88.9 and 79.3% for the NOG versus 75.0 and 65.9% for the OG (P = 0.027), respectively. Postoperative neurological events and operative mortality were, respectively, 3- and 4-fold higher in octogenarians undergoing AVR using DHCA. Such patients may represent suitable candidates for TAVR if favourable outcomes are demonstrated in patients with atherosclerotic aortas. Surgical AVR remains the standard treatment option with excellent outcomes for patients <80 years old with unclampable aortas.

Head and Neck Free Flap Reconstruction in Patients Older than 80 Years

Free tissue transfer is a reliable method for reconstruction of head and neck defects. With the growing number of octogenarians in the population, it is important to understand how these patients respond to these procedures. Through a retrospective chart review of patients who underwent a free-flap reconstruction from 2000 to 2010 at an academic medical center, 48 patients, aged 80 years and older, were compared with a control group consisting of 97 similar patients, aged younger than 80 years. We compared the intensive care unit (ICU) length of stay, overall hospital stay, and the incidence of perioperative complications between the cohorts. The average length of stay in the ICU was significantly longer for the octogenarian group as compared with the younger group (101 vs. 41 hours, p-value = 0.007). The average length of hospital stay was not significantly different between the two groups (difference = 40 hours, p-value = 0.102). The incidence of perioperative complication was 75% in the octogenarian group and 60% in the younger group (p-value = 0.095). There were two flap failures in the younger group, and none in the octogenarian group. There was a significantly higher rate of death within 30 days in the octogenarian group. Microvascular free tissue transfer is a reliable and safe method of reconstruction of head and neck defects in patients over 80 years of age. Patients should be counseled about the potential risks of increased incidence of medical complications, ICU length of stay, and rate of perioperative death when recommended to undergo free tissue transfer reconstruction.

Results of F-EVAR in Octogenarians

To evaluate the clinical outcomes after fenestrated endovascular aortic aneurysm repair (F-EVAR) in octogenarians. Between 2002 and 2012, all data from patients treated with custom-made fenestrated endografts for elective juxtarenal or pararenal aortic aneurysms in 2 high-volume centers (Malmö, Sweden & Lille, France) were prospectively entered in a computer database. Demographics and perioperative and follow-up results of patients aged ≥80 years (group 1) and patients aged <80 (group 2) were compared. A total of 288 patients (33 in group 1 and 255 in group 2) were treated with fenestrated endografts during the study period. Except for median age, tobacco use, and maximal transaortic diameter (P = 0.001), both groups were comparable. The number of fenestrations, procedure duration, contrast media volume, length of stay, and number of secondary interventions were comparable. The 30-day mortality rate was higher in the octogenarian group (9% vs. 1.6%, P = 0.041). Median follow-up was 25 months. Two-year survival rate according to Kaplan-Meier method was 77.8% in group 1 (95% confidence interval, 61.8-93.9) and 89.0% in group 2 (P = 0.121). Overall mortality during the follow-up period was significantly higher in octogenarians (P < 0.006). F-EVAR in octogenarians is associated with a higher 30-day mortality rate but has similar midterm outcomes compared with younger patients and should be considered as an acceptable therapeutic option in patients with satisfactory life expectancy.