Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90)

Irojah, Busayo; Bell, Theodore; Grim, Rod; Martin, Jennifer K.; Ahuja, Vanita

doi:10.7812/tpp/16-013

Cited by 21 publications

(16 citation statements)

References 45 publications

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“…The prevalence of complications was low (11.3%), following world's statistics 5,[23][24][25] . Only one death was observed (0.29%), representing a low mortality rate, similar to other studies 10,24,26,27 . The severity of the complications was assessed using CDC 28 Another factor that may play a role in the appearance of complications is surgical duration 19 .…”

Section: Discussionsupporting

confidence: 90%

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Fatores de risco para morbimortalidade em colecistectomia videolaparoscópica eletiva em idosos.

Mesquita

Iglesias

2018

Rev. Col. Bras. Cir.

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RESUMO Objetivo: identificar fatores de risco para a ocorrência de complicações pós-operatórias em colecistectomias videolaparoscópicas (CVL) em pacientes idosos. Métodos: estudo observacional com análise de prontuários médicos de pacientes com idade igual ou superior a 60 anos, submetidos à colecistectomia videolaparoscópica eletiva no Hospital Universitário Gaffrée e Guinle, entre os anos de 2006 e 2018. Cirurgias realizadas em regime de emergência ou convertidas para a técnica convencional foram excluídas do estudo. Resultados: foram incluídos no estudo 345 pacientes, sendo 80% do sexo feminino e 62% com idade entre 60 e 69 anos. Houve 39 casos de complicações pós-operatórias (11,3%), em sua maioria (87%) classificadas como tipo I ou II da escala de complicações cirúrgicas de Clavien-Dindo. Houve somente um caso de óbito. Presença e quantidade de doenças coexistentes e classificação de estado físico ASA II ou III conferiram risco maior para o desenvolvimento de complicações e mortalidade pós-operatórias. Conclusão: o estudo identificou a presença de doenças coexistentes e a gravidade das mesmas, segundo a classificação ASA, como fatores de risco para o desenvolvimento de complicações no pós-operatório de colecistectomias videolaparoscópicas em pacientes idosos. Entretanto, a CVL se mostrou uma técnica segura quando empregada nestes pacientes com taxas de morbimortalidade baixas.

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Section: Discussionsupporting

confidence: 90%

“…Despite some initial resistance in the use of laparoscopic technique for cholecystectomy in elderly, nowadays this type of treatment is considered the gold standard 7,8 . Recent studies have shown that the advantages of the minimally invasive technique are also observed when it is applied in elderly patients [9][10][11][12] Figure 1).…”

mentioning

confidence: 99%

Fatores de risco para morbimortalidade em colecistectomia videolaparoscópica eletiva em idosos.

Mesquita

Iglesias

2018

Rev. Col. Bras. Cir.

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“…In most cholecystectomy studies, patients operated with closed surgery were reported to have lower mortality rates and shorter hospital stay, but primary OC is preferred more commonly in elderly patients. There as on for this is gallbladder disease being a more severe disease and the low threshold of surgeons for converting to open surgery during laparoscopy in elderly patients (19)(20)(21). Fukami et al (2014) stated that the most important reason for conversion to open surgery is the presence of a history of previous upper abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

Can Cholecystectomy Be Performed as Safely in Elderly Patients as It Is in Young Patients

Arslan¹,

Yilmaz²,

Erol³

et al. 2020

tjgeri

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In this study, we aimed to compare the surgical outcomes between elderly and young patients undergoing surgery for gallstone disease and determine variations in patient characteristics, if any. Materials and Method: Data of patients who underwent surgery for gallstone disease at a single center between 2010 and 2018 were analyzed retrospectively. Two patient groups were evaluated: patients <65 years and ≥65 years. Patient characteristics, preoperative outpatient clinic data, surgical data, and postoperative data were collected. Results: In total, 1,198 patients with a mean age of 54.77 ± 15.03 (15-91) years were assessed. Comorbid conditions, including cardiovascular disease, pulmonary disease, renal disease, and diabetes mellitus were significantly more common in elderly patients (p<0.001). Acute cholecystitis in the preoperative period was noted in 15.36% of young patients and in 30.4% of elderly patients (p<0.001). Need for emergency surgery was higher in elderly patients than in young patients [13.86% (47) and 9.31% (80), respectively] (p=0.021). Laparoscopic cholecystectomy and open cholecystectomy were performed in 98.37% and 1.04% of young patients, respectively, and in 92.62% and 3.53% of elderly patients, respectively (p<0.001). Among factors affecting the length of hospital stay in elderly patients, the duration of hospitalization was significantly longer in elderly patients who underwent emergency surgery, open surgery, needed additional surgery, and who had high American Society of Anesthesiologists scores (p<0.001, p<0.001, p=0.013, p<0.001, respectively). Conclusion: Complications rates associated with cholecystectomy are similar between young and elderly patients when appropriate surgical preparations are performed. Surgery for gallstone disease can be performed safely in elderly patients with low morbidity and mortality rates.

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“…A retrospective study demonstrated the feasibility of cholecystectomy in 1007 cases with mortality and complication rates of 5.5% and 17.2%, respectively. 1 Another retrospective study reported findings from the anesthesiologist's point of view regarding patients 100 years of age and older. 2 To the best of our knowledge, our report is the first English article describing the treatment of nonagenarian patients by laparoscopic urologic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, laparoscopic RN has been widely recognized as the standard treatment because of its equivalence to open RN for oncologic control and survival rate. 1 Elderly individuals are the fastest growing segment of the population. It is problematic for many clinicians to determine whether surgical intervention is appropriate in super-elderly patients with renal malignancy without metastasis because there is no effective treatment other than renal surgery.…”

Section: Introductionmentioning

confidence: 99%

Effective Treatment of Upper Urinary Tract Malignancies Using Laparoscopic Surgery in Three Nonagenarians in Poor General Condition: Are They Too Old for Surgery?

Sejima

Morizane

Hikita

et al. 2018

Journal of Endourology Case Reports

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Backgrounds: Surgical procedures in the elderly are associated with higher perioperative morbidity and mortality rates than in younger patients. This is especially significant because elderly individuals are more likely to be operated on now than in the past because they represent the fastest growing subset of the population in advanced countries. Our cases are three nonagenarian patients with renal malignancy in poor general condition and were effectively treated by laparoscopic surgery.Case Presentation: Case 1 was a 91-year-old male patient with a right renal cell carcinoma of pT1b N0 M0. Case 2 was a 92-year-old male patient with a right renal pelvic tumor of pT3 N0 M0. Case 3 was a 90-year-old female patient with a left renal pelvic tumor of pT2 N0 M0. Case 1 had an Eastern Cooperative Oncology Group performance status of 1. The status of cases 2 and 3 was both rated as 2. All three cases had grade 3A chronic kidney disease. Cases 2 and 3 also had deep vein thrombosis in the lower extremities and dementia. In addition, case 2 had coronary occlusive disease. All cases were treated by laparoscopic surgery and effectively discharged from hospital without major physical complications.Conclusion: This report is the first English-language article that describes treating nonagenarian patients by laparoscopic urologic surgery. An increasing number of nonagenarian patients present with urologic malignancies, and surgeons are frequently faced with the question, “Are they too old for surgery?” Our report suggests that laparoscopic surgery for renal malignancy in nonagenarian patients is feasible.

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Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90)

Cited by 21 publications

References 45 publications

Fatores de risco para morbimortalidade em colecistectomia videolaparoscópica eletiva em idosos.

Fatores de risco para morbimortalidade em colecistectomia videolaparoscópica eletiva em idosos.

Can Cholecystectomy Be Performed as Safely in Elderly Patients as It Is in Young Patients

Effective Treatment of Upper Urinary Tract Malignancies Using Laparoscopic Surgery in Three Nonagenarians in Poor General Condition: Are They Too Old for Surgery?

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