Age comorbidity scores as risk factors for 90-day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population-Based Study

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Abstract

Background: To estimate easily assessed preoperative factors for predicting 90-day mortality in patients with a pancreatic head adenocarcinoma (PHA) receiving a pancreaticoduodenectomy. Methods: We analyzed data from the Taiwan Cancer Registry Database of patients with a PHA who received a pancreaticoduodenectomy. Basic demographic characteristics, including gender and age, were categorized. The selection of preoperative comorbidities was based on the preoperative American Society of Anesthesiologists score and Charlson comorbidity index. Results: We enrolled 8490 patients with a PHA who received a pancreaticoduodenectomy without distant metastasis. Currently, a pancreaticoduodenectomy for a PHA achieves an overall 90-day mortality rate of 8.39%. Univariate and multivariate Cox regression analyses indicated that an older age (65-74 and ≥75 years) and specific comorbidities (chronic obstructive pulmonary disease, chronic kidney disease, dementia, and sepsis) were significant independent prognostic factors for predicting 90-day mortality after a pancreaticoduodenectomy. After adjustment, the adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) of subjects with middle and high comorbidity scores for 90-day mortality in 65 to 74-year-old patients were 1.36 (1.05-1.75) and 2.25 (1.03-4.90), respectively, compared to subjects with low comorbidity scores. The aHRs (95% CIs) of subjects with middle and high comorbidity scores for 90-day mortality in ≥75-year-old patients were 1.35 (1.07-1.78) and 2.07 (1.19-3.62), respectively, compared to those with low comorbidity scores. Conclusions: Elderly patients with a PHA and moderate or high comorbidity scores have an increased risk of 90-day mortality after a pancreaticoduodenectomy.

Original languageEnglish
JournalCancer Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Pancreaticoduodenectomy
Comorbidity
Adenocarcinoma
Mortality
Population
Confidence Intervals
Social Adjustment
Taiwan
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Dementia
Registries
Sepsis
Regression Analysis
Demography
Databases
Neoplasm Metastasis

Keywords

  • 90-day mortality
  • comorbidity
  • older age
  • pancreatic head adenocarcinoma
  • pancreaticoduodenectomy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

@article{5fef921b65a8473aba159b65884ba734,
title = "Age comorbidity scores as risk factors for 90-day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy: A National Population-Based Study",
abstract = "Background: To estimate easily assessed preoperative factors for predicting 90-day mortality in patients with a pancreatic head adenocarcinoma (PHA) receiving a pancreaticoduodenectomy. Methods: We analyzed data from the Taiwan Cancer Registry Database of patients with a PHA who received a pancreaticoduodenectomy. Basic demographic characteristics, including gender and age, were categorized. The selection of preoperative comorbidities was based on the preoperative American Society of Anesthesiologists score and Charlson comorbidity index. Results: We enrolled 8490 patients with a PHA who received a pancreaticoduodenectomy without distant metastasis. Currently, a pancreaticoduodenectomy for a PHA achieves an overall 90-day mortality rate of 8.39{\%}. Univariate and multivariate Cox regression analyses indicated that an older age (65-74 and ≥75 years) and specific comorbidities (chronic obstructive pulmonary disease, chronic kidney disease, dementia, and sepsis) were significant independent prognostic factors for predicting 90-day mortality after a pancreaticoduodenectomy. After adjustment, the adjusted hazard ratios (aHRs) (95{\%} confidence intervals [CIs]) of subjects with middle and high comorbidity scores for 90-day mortality in 65 to 74-year-old patients were 1.36 (1.05-1.75) and 2.25 (1.03-4.90), respectively, compared to subjects with low comorbidity scores. The aHRs (95{\%} CIs) of subjects with middle and high comorbidity scores for 90-day mortality in ≥75-year-old patients were 1.35 (1.07-1.78) and 2.07 (1.19-3.62), respectively, compared to those with low comorbidity scores. Conclusions: Elderly patients with a PHA and moderate or high comorbidity scores have an increased risk of 90-day mortality after a pancreaticoduodenectomy.",
keywords = "90-day mortality, comorbidity, older age, pancreatic head adenocarcinoma, pancreaticoduodenectomy",
author = "Shia, {Ben Chang} and Lei Qin and Lin, {Kuan Chou} and Fang, {Chih Yuan} and Tsai, {Lo Lin} and Kao, {Yi Wei} and Wu, {Szu Yuan}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/cam4.2730",
language = "English",
journal = "Cancer Medicine",
issn = "2045-7634",
publisher = "John Wiley and Sons Ltd",

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TY - JOUR

T1 - Age comorbidity scores as risk factors for 90-day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy

T2 - A National Population-Based Study

AU - Shia, Ben Chang

AU - Qin, Lei

AU - Lin, Kuan Chou

AU - Fang, Chih Yuan

AU - Tsai, Lo Lin

AU - Kao, Yi Wei

AU - Wu, Szu Yuan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: To estimate easily assessed preoperative factors for predicting 90-day mortality in patients with a pancreatic head adenocarcinoma (PHA) receiving a pancreaticoduodenectomy. Methods: We analyzed data from the Taiwan Cancer Registry Database of patients with a PHA who received a pancreaticoduodenectomy. Basic demographic characteristics, including gender and age, were categorized. The selection of preoperative comorbidities was based on the preoperative American Society of Anesthesiologists score and Charlson comorbidity index. Results: We enrolled 8490 patients with a PHA who received a pancreaticoduodenectomy without distant metastasis. Currently, a pancreaticoduodenectomy for a PHA achieves an overall 90-day mortality rate of 8.39%. Univariate and multivariate Cox regression analyses indicated that an older age (65-74 and ≥75 years) and specific comorbidities (chronic obstructive pulmonary disease, chronic kidney disease, dementia, and sepsis) were significant independent prognostic factors for predicting 90-day mortality after a pancreaticoduodenectomy. After adjustment, the adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) of subjects with middle and high comorbidity scores for 90-day mortality in 65 to 74-year-old patients were 1.36 (1.05-1.75) and 2.25 (1.03-4.90), respectively, compared to subjects with low comorbidity scores. The aHRs (95% CIs) of subjects with middle and high comorbidity scores for 90-day mortality in ≥75-year-old patients were 1.35 (1.07-1.78) and 2.07 (1.19-3.62), respectively, compared to those with low comorbidity scores. Conclusions: Elderly patients with a PHA and moderate or high comorbidity scores have an increased risk of 90-day mortality after a pancreaticoduodenectomy.

AB - Background: To estimate easily assessed preoperative factors for predicting 90-day mortality in patients with a pancreatic head adenocarcinoma (PHA) receiving a pancreaticoduodenectomy. Methods: We analyzed data from the Taiwan Cancer Registry Database of patients with a PHA who received a pancreaticoduodenectomy. Basic demographic characteristics, including gender and age, were categorized. The selection of preoperative comorbidities was based on the preoperative American Society of Anesthesiologists score and Charlson comorbidity index. Results: We enrolled 8490 patients with a PHA who received a pancreaticoduodenectomy without distant metastasis. Currently, a pancreaticoduodenectomy for a PHA achieves an overall 90-day mortality rate of 8.39%. Univariate and multivariate Cox regression analyses indicated that an older age (65-74 and ≥75 years) and specific comorbidities (chronic obstructive pulmonary disease, chronic kidney disease, dementia, and sepsis) were significant independent prognostic factors for predicting 90-day mortality after a pancreaticoduodenectomy. After adjustment, the adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) of subjects with middle and high comorbidity scores for 90-day mortality in 65 to 74-year-old patients were 1.36 (1.05-1.75) and 2.25 (1.03-4.90), respectively, compared to subjects with low comorbidity scores. The aHRs (95% CIs) of subjects with middle and high comorbidity scores for 90-day mortality in ≥75-year-old patients were 1.35 (1.07-1.78) and 2.07 (1.19-3.62), respectively, compared to those with low comorbidity scores. Conclusions: Elderly patients with a PHA and moderate or high comorbidity scores have an increased risk of 90-day mortality after a pancreaticoduodenectomy.

KW - 90-day mortality

KW - comorbidity

KW - older age

KW - pancreatic head adenocarcinoma

KW - pancreaticoduodenectomy

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U2 - 10.1002/cam4.2730

DO - 10.1002/cam4.2730

M3 - Article

C2 - 31789464

AN - SCOPUS:85076316288

JO - Cancer Medicine

JF - Cancer Medicine

SN - 2045-7634

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