Factors predicting hospitalization after operative treatment for gastric carcinoma in patients older than 70 years

BACKGROUND: Variable reports exist about the early and long-term outcome after operative treatment for gastric carcinoma in the elderly. This study was designed to describe perioperative morbidity and factors influencing the length of hospitalization in patients older than 70 years of age in a tertiary care cancer center. METHODS: Patient information for a 10-year period, between July 1985 and July 1995, was obtained through a prospective database and chart review. Complications and length of stay were tabulated. Patient-, disease-, and treatment-related factors and their influence on outcome were compared by univariate and multivariate analysis using nonparametric product-limit models. RESULTS: Of 385 patients aged 71 years or older with gastric adenocarcinoma, 310 underwent resection. Postoperative complications occurred in 47.1 percent. Infectious complications predominated, most frequently involving intra-abdominal and pulmonary sites. Perioperative mortality was 7.1 percent. The median postoperative length of stay was 13 days (95 percent confidence interval 12 to 14 days; 25th percentile, 10 days; 75th percentile, 20 days). Factors independently predicting an increased duration of stay were presence of any complications, the type of resection, site of the primary carcinoma, and presence of postoperative infection. Complications added 30.4 percent of total patient days, or an average of 11.5 hospital days per patient with a complication. Although patients with postoperative complications had inferior overall and disease-specific survival, this was not an independent prognostic variable. Compared with patients younger than 70 years of age, elderly patients had a significantly increased hospital stay. CONCLUSIONS: The single most important factor leading to increased length of hospitalization is the occurrence of any complication. Although complicated by higher morbidity and mortality, the resection of gastric carcinoma in elderly patients can be performed relatively safely and leads to survival that is comparable to younger patients. The findings support careful patient selection and optimal preparation of elderly patients undergoing resection for gastric carcinoma.