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

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.