Preoperative Workup by a Dedicated Geriatric Surgery Service Improves Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy

INTRODUCTION: Pancreaticoduodenectomy (PD) carries substantial risks in elderly patients, emphasizing the need for optimized perioperative care. Comprehensive geriatric assessments (CGAs) - evaluating medical, functional, and psychosocial domains - may mitigate these risks. This study investigates the impact of a preoperative evaluation by a dedicated geriatric surgery service on outcomes in elderly patients undergoing PD. METHODS AND MATERIALS: This was a retrospective cohort study of elderly (age over 75 years) patients that underwent PD (GA + 75, n = 23) following preoperative workup by a specialized geriatric surgery service (GSS). Control groups included elderly patients without geriatric assessment (non-GA + 75, n = 73) and non-elderly patients ( < 75 years, n = 275). Short- and long-term outcomes were compared across the groups. RESULTS: While baseline demographics were similar between GA + 75 and non-GA + 75 groups, comorbidity profiles differed. Higher rates of chronic obstructive pulmonary disease (21.7% vs. 2.7%, p = 0.002) and asthma (26% vs. 1.4%, p < 0.001) were observed in the GA + 75 group. Despite this, GA + 75 patients had significantly lower rates of postoperative pneumonia (4.3% vs. 18.1%, p < 0.001), readmission (26.1% vs. 41.6%, p < 0.001; also lower than the non-elderly cohort), and delirium (4.3% vs. 36.1%, p < 0.001). There were no significant differences in overall major complications or 30-/90-day survival rates as well as long-term outcomes between the groups. CONCLUSIONS: Preoperative evaluation by a dedicated GSS was associated with improved postoperative outcomes in elderly patients undergoing PD. These findings support the integration of CGAs into perioperative planning to enhance recovery and reduce complications in older adults.