Predictors of loss of independence in older adults undergoing pancreatectomy: a nationwide analysis.

BACKGROUND

Pancreatectomy carries significant risk of morbidity and mortality, particularly in the geriatric population; the risk of postoperative loss of independence (LOI) remains underexplored. The aim was to identify perioperative factors associated with LOI following pancreatectomy in this population.

METHODS

The NSQIP database was queried to identify adults ≥75 years who underwent pancreatectomy from 2021 to 2024. LOI was the primary outcome, defined as decline in functional status and/or non-home discharge and/or home discharge services. Multivariable logistic regression was performed to identify predictors of LOI.

RESULTS

Of 6227 patients, 1731(27.8%) experienced LOI at discharge. Factors associated with LOI included failure to wean from mechanical ventilation >48 h (OR 4.14,95%CI:2.19-7.85), cognitive impairment (OR 2.16,95%CI:1.50-3.10), and history of falls (OR 1.96,95%CI:1.56-2.48). Additional predictors included age >80 years (OR 1.4,95%CI:1.23-1.58), female sex (OR:1.26,95%CI:1.1-1.43), and COPD (OR 1.49,95%CI:1.13-1.95). The presence of home support prior to surgery (OR 0.81,95%CI:0.7-0.94) and early discharge (≤5 days) (OR 0.41,95%CI:0.33-0.51) were demonstrated to be protective.

DISCUSSION: The understanding of LOI in this population can facilitate preoperative counseling and expectation setting. Care teams should work to mitigate LOI and/or obtain necessary support in the perioperative period.