Cholecystectomy in octogenarians: be careful

Abstract

Cholecystectomy is the standard treatment for symptomatic gallstone or acute cholecystitis, and a growing number of elderly patients are undergoing resection. The aim of this study is to evaluate the clinical outcome of cholecystectomy in elderly patients. We retrospectively reviewed the medical records of 337 patients with symptomatic gallstone or acute cholecystitis who underwent cholecystectomies between January 2011 and June 2013. Perioperative data were compared between octogenarians and younger patients. A subgroup undergoing cholecystectomy for acute cholecystitis (n = 146, 43.3 %) was further analyzed. The octogenarian group included 34 patients (10.1 %), while the younger patient group included 303 patients (89.9 %). The octogenarian group was associated with higher rates of comorbidities and acute cholecystitis. The octogenarian group had significantly low laparoscopic completed rates, high postoperative complication rates, and longer postoperative hospital stays. Among the acute cholecystitis group, 24 patients (16.4 %) were octogenarians and 122 patients (83.6 %) were younger patients. No significant difference was found in the morbidity and postoperative hospital stay between the two groups. Only one patient (0.3 %), an octogenarian, died of pneumonia. Cholecystectomy for symptomatic gallstone or acute cholecystitis can be safely performed even in octogenarians. However, care should be taken because they have comorbidities and limited functional reserves.

Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

“…Yet, 4 of the 5 included studies comparing perioperative outcomes of early cholecystectomy in elderly and younger patients showed no significant difference in terms of perioperative morbidity or mortality [17][18][19]21] . Only one study proved older age to be independently associated with increased morbidity [20] .…”

“…Minor complications such as wound infections were also frequently encountered but had minor impact on the final outcome. It is noteworthy that only 2 studies [17,19] reported on the severity of each complication, both by using the Clavien-Dindo classification [26] . The remaining studies neither mentioned the severity of the complications nor whether the patients had fully recovered from the complications.…”

“…A recent meta-analysis of observational studies showed that advanced age is associated with increased risk of conversion, although no obvious explanation is given [28] . Dense adhesions due to previous episodes of complicated gallstone disease or previous abdominal surgery, or perioperative cardiopulmonary complications may be the reason [19,21] . In the present review, only 2 studies [22,23] reported on the morbidity in the converted patients, showing no significant differ- An alternative for urgent cholecystectomy in elderly patients is percutaneous drainage in addition to appropriate systemic support and antibiotic treatment.…”

“…To reduce the risk of perioperative morbidity and mortality, a severity assessment of pre-existing comorbid conditions should be performed. This review showed that patients who died had been suffering from severe pre-existent comorbidities or a poor clinical preoperative condition [18,19,23] . Careful selection of elderly patients who may benefit from surgery, that is, those patients in good physical health having very few comorbidities, may contribute to a better perioperative outcome.…”

“…Three studies [18,19,23] reported the characteristics of the patients who died, showing that they all suffered from severe pre-existent comorbidities or had a poor clinical preoperative condition. The estimated pooled mortality was 3.5% (95% CI 2.3-5.4).…”