Establishing standards of quality for elderly patients undergoing pancreatic resection

Wande B. Pratt, Anupama Gangavati, Kathryn Agarwal, Robert Schreiber, Lewis A. Lipsitz, Mark P. Callery, Charles M. Vollmer

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: To evaluate pancreatic surgery as a model for high-acuity surgery in elderly patients for immediate and long-term outcomes, predictors of adverse outcomes, and hospital costs. Design: Retrospective case series. Setting: University tertiary care referral center. Patients: Four hundred twelve consecutive patients who underwent pancreatic resection from October 1, 2001, through March 31, 2008, for benign and malignant periampullary conditions. Main Outcome Measures: Clinical outcomes were compared for elderly (≥75 years) and nonelderly patient cohorts. Quality assessment analyses were performed to show the differential impact of complications and resource utilization between the groups. Results: The elderly cohort constituted one-fifth of all patients. Benchmark standards of quality were achieved in this group, including low operative mortality (1%). Despite higher patient acuity, clinical outcomes were comparable to those of nonelderly patients at a marginal cost increase (median, $2202 per case). Cost modeling analysis showed further that minor and moderate complications were more frequent but no more debilitating for elderly patients. Major complications, however, were far more threatening to older patients. In these cases, duration of hospital stay doubled, and invasive interventions were more commonly deployed. Conclusions: Quality standards for pancreatic resection in the elderly can-and should-mirror those for younger patients. Age-related care, including geriatric consultation, supplemental enteral nutrition, and early rehabilitation placement planning, can be designed to mitigate the impact of complications in the elderly and guarantee quality.

Original languageEnglish (US)
Pages (from-to)950-956
Number of pages7
JournalArchives of Surgery
Volume144
Issue number10
DOIs
StatePublished - Oct 1 2009
Externally publishedYes

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Tertiary Care Centers
Patient Acuity
Costs and Cost Analysis
Benchmarking
Hospital Costs
Enteral Nutrition
Geriatrics
Length of Stay
Referral and Consultation
Rehabilitation
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Pratt, W. B., Gangavati, A., Agarwal, K., Schreiber, R., Lipsitz, L. A., Callery, M. P., & Vollmer, C. M. (2009). Establishing standards of quality for elderly patients undergoing pancreatic resection. Archives of Surgery, 144(10), 950-956. https://doi.org/10.1001/archsurg.2009.107

Establishing standards of quality for elderly patients undergoing pancreatic resection. / Pratt, Wande B.; Gangavati, Anupama; Agarwal, Kathryn; Schreiber, Robert; Lipsitz, Lewis A.; Callery, Mark P.; Vollmer, Charles M.

In: Archives of Surgery, Vol. 144, No. 10, 01.10.2009, p. 950-956.

Research output: Contribution to journalArticle

Pratt, WB, Gangavati, A, Agarwal, K, Schreiber, R, Lipsitz, LA, Callery, MP & Vollmer, CM 2009, 'Establishing standards of quality for elderly patients undergoing pancreatic resection', Archives of Surgery, vol. 144, no. 10, pp. 950-956. https://doi.org/10.1001/archsurg.2009.107
Pratt, Wande B. ; Gangavati, Anupama ; Agarwal, Kathryn ; Schreiber, Robert ; Lipsitz, Lewis A. ; Callery, Mark P. ; Vollmer, Charles M. / Establishing standards of quality for elderly patients undergoing pancreatic resection. In: Archives of Surgery. 2009 ; Vol. 144, No. 10. pp. 950-956.
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