1. How could we identify the 'old' patient in gastric cancer surgery? A single centre cohort study
- Author
-
Silvia Ministrini, Gian Luca Baiocchi, Nazario Portolani, Leonardo Solaini, Arianna Coniglio, Guido A. M. Tiberio, Sara Cavallari, Beatrice Molteni, Solaini, Leonardo, Ministrini, Silvia, Coniglio, Arianna, Cavallari, Sara, Molteni, Beatrice, Baiocchi, Gian Luca, Portolani, Nazario, and Tiberio, Guido Alberto Massimo
- Subjects
Male ,Multivariate analysis ,Complications ,medicine.medical_treatment ,Elderly ,Gastrectomy ,Gastric cancer ,Old patient ,Surgery ,0302 clinical medicine ,Postoperative Complications ,Retrospective Studie ,Risk Factors ,Hospital Mortality ,Multivariate Analysi ,Aged, 80 and over ,education.field_of_study ,Age Factors ,General Medicine ,030220 oncology & carcinogenesis ,Cohort ,030211 gastroenterology & hepatology ,Female ,Human ,Cohort study ,medicine.medical_specialty ,Population ,Operative Time ,03 medical and health sciences ,Stomach Neoplasm ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Adverse effect ,education ,Serum Albumin ,Aged ,Retrospective Studies ,business.industry ,Risk Factor ,Retrospective cohort study ,Multivariate Analysis ,Postoperative Complication ,business ,Complication ,Cancer surgery - Abstract
Purpose To analyze the population submitted to gastric cancer surgery in our Institution in order to find those characteristics which could help in the identification of the elderly high-risk patient. Methods In a cohort of 263 patients (>65 y) we selectively investigated the risk factors for medical and surgical complications and postoperative mortality, focusing on the variable "age". All the significant variables were used to find predictors of complications with Clavien-Dindo>2. Results Age>75 (AUC 0.61; 95% 0.55–0.67, p = 0.003) and ASA score >2 (AUC 0.60; 95% CI 0.54–0.67, p = 0.01) were significantly associated with an increased risk of medical complications. Operative time >330 min (OR 1.00; 95% CI 1.00–1.01; p = 0.0001- AUC 0.62, 95% CI 0.56–0.68, p = 0.01) was the only significant predictor of surgical complications. In-hospital mortality (6/263 patients) was significantly associated with preoperative albumin ≤2.95 g/dl (OR 0.15; 95% CI 0.04–0.93, p = 0.041 – AUC 0.74 95% CI 0.68–0.80; p = 0.003) and additional procedures (OR 7.05; 1.23–40.32, p = 0.03). Stepwise multivariate analysis showed that albumin ≤2.95 g/dl (OR 3.43; 95% CI 1.06–11.13 p = 0.033), ASA>2 (OR 9.51; 95% CI 1.23–72.97; p = 0.042) and additional resections (OR 3.39; 95% CI 1.36–8.45; p = 0.045) were independent risk factors for complications Clavien Dindo >2. Conclusions Our work demonstrated that, in our institution, 75 years of age could identify the elderly in gastric surgery as those patients were at higher risk of medical complications. ASA >2, preoperative serum albumin ≤2.95 g/dl and the need of additional procedures could increase the risk of severe postoperative adverse events.
- Published
- 2016