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

Abstract

Background: In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase. This systematic review aimed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis. Methods: Medline, Embase, and Cochrane Library databases were systematically searched for studies reporting on early cholecystectomy for acute cholecystitis in patients aged ≥70 years. The conversion rate, perioperative morbidity, and mortality were calculated using a random-effects model. Results: Eight articles fell within the scope of this study. In total, 592 patients were identified. The mean age was 81 years. Early cholecystectomy was performed laparoscopically in 316 patients (53%) and open in 276 patients (47%). The procedure was associated with a conversion rate of 23% (95% CI 18.6-28.3), a perioperative morbidity of 24% (95% CI 20.5-27.5), and a mortality of 3.5% (95% CI 2.3-5.4). Conclusion: Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis. To reduce morbidity, patients who may benefit from surgery ought to be selected carefully. Future prospective studies should compare early cholecystectomy with alternative treatments to select the treatment that is most appropriate for elderly patients.

Clinical characteristics and short‐term outcomes in patients with acute cholecystitis over aged >80 years

“…7 A recent meta-analysis in 2017 has reported a perioperative morbidity of 24% and a mortality of 3.5% in AC patients aged ≥70 years undergoing early cholecystectomy, suggesting that early cholecystectomy is a feasible treatment, even in elderly AC patients. 9 Of note, the proportion of AC patients aged ≥80 years who received percutaneous drainage as a definitive first-line treatment without subsequent cholecystectomy significantly increased over time in the current study. A report from Taiwan also showed that the rate of percutaneous cholecystostomy (PC) in the AC patients ≥70 years of age increased from 7.2% in 2010 to 31.8% in 2015.…”

“…Conversely, however, Fuks et al found no significant differences in the rate of postoperative complications between elderly grade I or II AC patients aged ≥75 years and their younger counterparts, although the elderly participants had a higher Charlson Comorbidity Index than the younger patients . A recent meta‐analysis in 2017 has reported a perioperative morbidity of 24% and a mortality of 3.5% in AC patients aged ≥70 years undergoing early cholecystectomy, suggesting that early cholecystectomy is a feasible treatment, even in elderly AC patients …”

“…It is reported that urgent cholecystectomy in elderly patients is reportedly associated with increased rates of serious complications (up to 41%) and mortality (up to 4.5%) compared with younger patients . However, findings regarding the safety of treatment and outcomes in elderly patients with AC are conflicting …”

“…3,4 However, findings regarding the safety of treatment and outcomes in elderly patients with AC are conflicting. [5][6][7][8][9] Japan now has the largest aging population in the world, and the average life expectancy of a Japanese person in 2016 was 80.98 years among men and 87.14 among women. 10 The aging of society is expected to continue in the future, resulting in a dramatic increase in the opportunities to examine elderly AC patients aged ≥80 years in Japan.…”

Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution

“…Similarly, DLC has been defined, for example, as surgery performed 6-12 weeks after symptom onset or 7-45 days after admission (3)(4)(5). In addition, reports vary as to whether percutaneous transhepatic gallbladder drainage (PTGBD) performed before DLC is beneficial (9)(10)(11)(12)(13)(14).…”