Outcomes of operations for benign foregut disease in elderly patients: A National Surgical Quality Improvement Program database analysis

Background. The development of minimally invasive operative techniques and improvement in postoperative care has made surgery a viable option to a greater number of elderly patients. Our objective was to evaluate the outcomes of laparoscopic and open foregut operation in relation to the patient age. Methods. Patients who underwent gastric fundoplication, paraesophageal hernia repair, and Heller myotomy were identified via the National Surgical Quality Improvement Program (NSQIP) database (2005-2011). Patient characteristics and outcomes were compared between five age groups (group I: 65 years, II: 65-69 years; III: 70-74 years; IV: 75-79 years; and V: 80 years). Multivariable logistic regression analysis was used to predict the impact of age and operative approach on the studied outcomes. Results. A total of 19,388 patients were identified. Advanced age was associated with increased rate of 30-day mortality, overall morbidity, serious morbidity, and extended length of stay, regardless of the operative approach. After we adjusted for other variables, advanced age was associated with increased odds of 30-day mortality compared with patients <65 years (III: odds ratio 2.70, 95% confidence interval 1.34-5.44, P = .01; IV. 2.80, 1.35-5.81, P = .01; V. 6.12, 3.4140.99, P < .001). Conclusion. Surgery for benign foregut disease in elderly patients carries a burden of mortality and morbidity that needs to be acknowledged.