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Reduced functional status tied to greater complications, mortality after hepatic resection in elderly patients

Elderly patients unable to complete daily living tasks without assistance are at particularly increased risk for complications and mortality after hepatic resection, according to a recent study.

Researchers performed a retrospective analysis of 5,706 patients who underwent hepatic resection between 2005 and 2009. Data was collected from National Surgical Quality Improvement Program Participant User Files (NSQIP-PUF) and included 1,280 patients aged 70 years or older. Incidence of overall and serious complications, along with mortality rates at 30 days, was observed and compared according to patient age.

Older patients were more likely to experience complications (26.6% of cases vs. 23.1%; P<.01) and serious complications (18.4% vs. 15.2%; P<.006). Mortality at 30 days also was significantly more common (4.5% of cases vs. 1.9%; P<.0001), and the median length of hospital stay after the procedure was longer among elderly patients (7 days vs. 6 days; P<.0001).

The factor associated most strongly with complications and mortality was a functional status other than independent, as indicated by the NSQIP (needing some or total assistance to complete activities associated with daily living). Investigators calculated ORs of 6.59 (95% CI, 2.46-17.6) for the incidence of any complication, 5.55 (95% CI, 2.12-14.5) for serious complications and 6.11 (95% CI, 1.59-23.5) for 30-day mortality.

Older age, receiving intraoperative transfusion, undergoing trisegmentectomy, longer surgery duration and diabetes also were predictive of any complications, serious complications and mortality. Primary hepatic malignancy or a bleeding disorder, weight loss and steroid use were associated with increased risk for 30-day mortality, while disseminated cancer was associated with a reduced risk.

“Our study shows increased morbidity and mortality rates in elderly patients undergoing hepatic resections at a variety of surgical centers throughout the United States,” the researchers wrote. “In this study, a reduced functional status was found to have the greatest predictive value for postoperative morbidity and mortality after hepatectomy. … Age and functional status should be taken into consideration when counseling patients on the morbidity and mortality associated with this operation.”