Clinical outcomes of laparoscopic cholecystectomy in elderly patients after preoperative assessment and optimization of comorbidities

Abstract

Backgrounds/AimsEarly laparoscopic cholecystectomy is considered as the standard treatment of acute cholecystitis. However, whether this procedure is desirable in elderly patients with acute cholecystitis is not clearly elucidated. In this study, we aimed to evaluate the effects of thorough preoperative assessment and consultation for complications on clinical outcomes in elderly patients over 65 and over 80 years.MethodsWe retrospectively analyzed 205 patients who were diagnosed with acute cholecystitis between January 2010 and April 2018. The patients were assigned to three groups: group A (aged <65 years), group B, (aged between 65 and 79 years), and group C (aged >79 years). Laparoscopic cholecystectomy was performed after preoperative evaluation, such as echocardiography, pulmonary function test, and consultation about past history.ResultsSignificant differences were not found in the complication rate among the age groups. Open conversion was required in eight of the 114 patients in group A, seven of the 70 patients in group B, and one of the 21 patients in group C. However, no statistical significance was found. Moreover, no difference was noted in the start of the meal and the period from surgery to last visit, but hospital stay after surgery was longer in groups b and c.ConclusionsWhen sufficient preoperative assessment and treatment were performed, complication and conversion rates were not significantly different among the age groups. In extremely elderly patients, preoperative evaluation and elective laparoscopic cholecystectomy were desirable.

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

“…There were no significant differences regarding cardiovascular complications between the four age-groups. Similar findings are also encountered by Shin et al [ 38 ]. With the pre-operative optimization of comorbidities and medications and addressing frailty in a multi-disciplinary team, an experienced surgical staff with good technical equipment are effective in improving postoperative outcomes [ 16 , 38 ].…”

“…Similar findings are also encountered by Shin et al [ 38 ]. With the pre-operative optimization of comorbidities and medications and addressing frailty in a multi-disciplinary team, an experienced surgical staff with good technical equipment are effective in improving postoperative outcomes [ 16 , 38 ]. Moreover, the multivariate analysis showed that severe inflammation (gangrenous cholecystitis) and comorbidities such as diabetes, previous stroke and chronic renal and pulmonary disease, but not age itself, are risk factors for postoperative morbidity.…”

“…This loss of reserve capacity is the single most important factor that decreases the elderly patient’s ability to tolerate operations. The proper management of fluid and electrolyte replacement, respiratory management to prevent atelectasis and pneumonia, and monitoring for possible cardiac complications are necessary to minimize the risk of systemic complications in the perioperative period [ 2 , 3 , 37 , 38 ].…”

HDAC2 hyperexpression alters hippocampal neuronal transcription and microglial activity in neuroinflammation-induced cognitive dysfunction

“…Peri-inflammatory conditions in the abdomen induce pathological and molecular changes in the brain [1-4]. Brain uptake of circulating lipopolysaccharide (LPS) is not sufficient to cross the brain-blood barrier (BBB) that most effects of peripherally administered LPS are mediated through LPS receptors located outside the BBB [5].…”

Is cholecystectomy safe in extremely elderly patients?

“…Although many studies have demonstrated the advantages of perioperative outcomes of early cholecystectomy in elderly and younger patients, several of them showed no difference in postoperative morbidity or mortality [ 5 , 6 ]. A recent meta-analysis of systematic review has shown that careful selection of elderly patients contributes to a better perioperative outcome, but there is no uniform guidance on selection or preoperative assessment [ 7 ].…”