Impact of Ageing on Hepatic Malignancy Resection: Is Age Really a Risk Factor for Mortality?
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ORIGINAL SCIENTIFIC REPORT
Impact of Ageing on Hepatic Malignancy Resection: Is Age Really a Risk Factor for Mortality? Jianliang Liu1 Guy Maddern4
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Jessica Reid2 • Markus Trochsler2 • Lisa Leopardi2 • Suzanne Edwards3
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Accepted: 18 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background With an ageing population, it is paramount for surgeons to comprehend the implications of age on surgical outcomes. This study aims to identify the effects of age on perioperative outcomes post-hepatectomy. Methods Between 2001 and 2017, 357 hepatectomies were performed in our centre for malignancy. Data recorded include demographic, histopathology and perioperative outcomes. Patients were divided into three age groups (Group 1 \ 65 years, Group 2 65–74 years, Group 3 C 75 years). Results With increasing age, there was a trend towards patient having: ASA C 3 (from 32.1% to 60.9%, p \ 0.0001), clear margins (from 80.4% to 88.3%, p = 0.2256), days of hospitalisation (from 9.5 ± 6.9 to 12 ± 8.0, p = 0.0003), days of ICU admission (from 2.3 ± 2.8 to 2.8 ± 12.9, p = 0.0790) and morbidity (from 39% to 58.5%, p = 0.0073). Cardiovascular complications and postoperative delirium increase with age. There was no significant difference in mortality across the three groups. Univariate and bivariate binary logistic regressions found no association between mortality and age. When adjusted for age, 30- and 90-day mortality was significantly associated with Clavien–Dindo C 3, length of hospital and cardiac complications. Additionally, 90-day mortality was significantly associated with ASA score C3, mass of liver resected, length of ICU stay and hepatobiliary, pulmonary and genitourinary complications. Conclusion Increased age is associated with increased post-hepatectomy complications, prolonged hospital stay and ICU admission. However, age itself is not a contraindication for hepatectomy and is not associated with increased mortality. Good histopathology outcomes and low mortality rates are achievable with careful patient selection and appropriate perioperative management.
& Guy Maddern [email protected] 1
Faculty of Health and Medical Sciences, The University of Adelaide Medical School, Adelaide, South Australia, Australia
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Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
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Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, 28 Woodville Road, Woodville, South Australia 5011, Australia
Introduction Increasing life expectancy and falling birth rates have resulted in a rapid growth in ageing population worldwide. The United Nations projects that the number of octogenarians globally would triple from 143 million in 2019 to 426 million in 2050 [1]. An ageing population is one of the most consequential social transformations in the twentyfirst century, impacting every sector, i
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