{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:01:28Z","timestamp":1787018488139,"version":"build-2736575974"},"reference-count":20,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T00:00:00Z","timestamp":1717545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>Background: The frequency of major cancer surgery in the elderly (\u226580\u00a0years) has increased concomitantly with the rise in average age of the population. We assessed early postoperative mortality following hepato-pancreato-biliary (HPB) and gastrointestinal (GI) procedures for common malignancies stratified by age. Methods: The National Cancer Database (2004-2017) was queried for patients who underwent resection for GI (gastroesophageal and colorectal) or HPB (pancreatic adenocarcinoma, biliary tract, and primary liver) cancers. We compared early postoperative mortality (30\u00a0d and 90\u00a0d) stratified by age (65-79 vs \u226580\u00a0years) and procedure, and compared survival outcomes by age and operative vs nonoperative management. Results: A total of 709,358 patients were included. The 30-day mortality ranged from 1.8% to 5.8% among patients 65-79\u00a0years and from 3.2% to 12.4% among patients \u226580\u00a0years depending on procedure. The 90-day mortality ranged from 3.6% to 10.6% in patients 65-79\u00a0years compared to 8.4%-21.0% among patients \u226580\u00a0years. The overall 90-day mortality was 5.2% for patients 65-79\u00a0years and 12.0% for patients \u226580\u00a0years ( P &lt; .001). Age \u226580 was associated with worse survival among operatively managed patients with each upper GI, HPB, and lower GI malignancy relative to younger patients on multivariable analysis. However, operative management of patients \u226580\u00a0years was associated with improved survival relative to nonoperative management. Discussion: Elderly patients suffer higher postoperative mortality after major GI and HPB cancer surgery, but operative management is associated with improved survival among patients \u226580\u00a0years as compared to nonoperative management. These data are important to contextualize when counseling elderly patients on their treatment options for localized GI and HPB cancers.<\/jats:p>","DOI":"10.1177\/00031348241256057","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T20:38:20Z","timestamp":1717619900000},"page":"2940-2950","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["An Age-Stratified Analysis of Early Postoperative Mortality Among Medicare-Eligible Patients With Common Gastrointestinal and Hepato-pancreato-biliary Malignancies"],"prefix":"10.1177","volume":"90","author":[{"given":"Alexander W.","family":"Loftus","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Hue","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamedraed","family":"Elshami","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Miller-Ocuin","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Steinhagen","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard S.","family":"Hoehn","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke D.","family":"Rothermel","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B.","family":"Ammori","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Hardacre","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee M.","family":"Ocuin","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,5]]},"reference":[{"key":"bibr1-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2009.00581.x"},{"key":"bibr2-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.8-6-541"},{"key":"bibr3-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-4036-4"},{"key":"bibr4-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.10.057"},{"key":"bibr5-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12572"},{"key":"bibr6-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001048"},{"key":"bibr7-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-021-04949-8\/Published"},{"key":"bibr8-00031348241256057","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27134"},{"key":"bibr9-00031348241256057","volume-title":"National 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