- 27.8% experienced loss of independence after pancreatectomy; strongest predictors were prolonged mechanical ventilation >48 hours (OR 4.14), cognitive impairment, and prior falls.
- Age over 80, female sex, and COPD independently increased risk of loss of independence at discharge.
- Preoperative home support and early discharge within five days were protective, reducing odds of loss of independence.
HPB (Oxford). 2026 Jul 17:S1365-182X(26)00700-8. doi: 10.1016/j.hpb.2026.07.006. Online ahead of print.
ABSTRACT
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.
PMID:42629295 | DOI:10.1016/j.hpb.2026.07.006
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