The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis

Abstract

Background/Aims: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. Methods: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. Results: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). Conclusions: Although elderly ­patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

“…Finally, the outcome of donors with BMI ≥ 30 was compared to those with BMI < 30 using a propensity score matching (PSM). The PSM was conducted using a logistic regression model including preoperative variables with P value < 0.20 (6 variables in total), as previously reported [11]. Propensity scores were matched with one-to-one ratio using a caliper width 0.20 of the standard deviation.…”

Treatment Outcomes and the Safety of Chemoradiotherapy With High-Dose CDDP for Elderly Patients With Head and Neck Squamous Cell Carcinoma: A Propensity Score Matching Study

“…PSM is now a widely accepted statistical approach that enables robust comparisons (15). Moreover, several studies have focused on the effects of aging using PSM to avoid confounding differences because of a variability in background factors between elderly and younger patients (16)(17)(18). There were statistically significant differences in the PS, BMI, and primary tumor site, including p16 positive oropharynx cancer before PSM, all of which were corrected following PSM (Table 1).…”

“…We conducted PSM to avoid confounding differences between the elderly and the non-elderly groups (16)(17)(18). The propensity scores were estimated using a logistic regression model based on background factors that might impact the CRT outcomes (18).…”

“…In this multicenter retrospective study, we aimed to compare the safety and treatment outcomes of concurrent CRT using high-dose, single-agent CDDP between elderly and non-elderly patients with HNSCC. To reduce the patient selection bias and to determine the causal effects of age, we performed propensity score matching (PSM), an assessment that adjusts the balance of patient characteristics between two groups (15)(16)(17)(18). The outcomes and safety were compared before and after PSM.…”

The accuracy of pre-operative (P)-POSSUM scoring and cardiopulmonary exercise testing in predicting morbidity and mortality after pancreatic and liver surgery: A systematic review

“…Hepatopancreaticobiliary (HPB) surgical procedures are often complex providing both a technical challenge to the surgeon and a significant physiological insult to the patient [ 1 ]. Despite improvements with both mortality and medical complications, procedure-specific complications remain a significant source of morbidity [ [1] , [2] , [3] ].…”