Elective and emergency laparoscopic cholecystectomy in the elderly: our experience

Ferrarese, Alessia; Solej, Mario; Enrico, Stefano; Falcone, Alessandro; Catalano, Silvia; Pozzi, Giada; Marola, Silvia; Martino, Valter

doi:10.1186/1471-2482-13-s2-s21

Cited by 33 publications

(11 citation statements)

References 16 publications

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“…All surgeries in this study were performed by experienced attending surgeons. Laparoscopic cholecystectomy [ 15 ] was carried out using four incisions with pneumoperitoneum installed via a sub-umbilical mini-laparotomy with the maximum intraabdominal pressure kept at 12 mmHg.…”

Section: Methodsmentioning

confidence: 99%

Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

et al. 2014

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IntroductionEarly cholecystectomy within 72 hours has been shown to be superior to late or delayed cholecystectomy with regard to outcome and cost of treatment. Recently, immediate cholecystectomy within 24 hours of onset of symptom was proposed as standard procedure for the management of fit patients presenting with acute cholecystitis. We sort to find out if there are any differences in surgical outcomes between patients managed within 24 h and those managed 25-72 h following symptom begin for acute cholecystitis.Patients and methodsA retrospective analysis was performed. The outcomes of patients undergoing laparoscopic cholecystectomy within 24 h were compared to those of patients managed 25-72 h following symptom onset for acute cholecystitis.Results35 patients managed 25-72 h following begin of symptoms were matched with 35 patients with similar baseline features, medical comorbidities and disease severity managed within 24 hours of symptom onset. There were no significant differences in the duration of surgery, postoperative complications, rate of conversion and length of hospital stay.ConclusionImmediate laparoscopic cholecystectomy for acute cholecystitis within 24 hour of symptom onset is not superior to surgery 25–72 hour after symptoms begin. Laparoscopic cholecystectomy for acute cholecystitis therefore can be safely performed anytime within the golden 72 h.

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Section: Methodsmentioning

confidence: 99%

Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

et al. 2014

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“…11 For example, insufflating carbon dioxide during laparoscopy may cause acid-base disturbances and changes in cardiopulmonary physiology that are otherwise avoided in the open approach. [23][24][25] Despite these concerns, systematic studies indicate that laparoscopic procedures in elderly patients offer many advantages, such as lower pain and convalescence, and clinicians still tend to prefer laparoscopy in the elderly in both emergent or elective settings. 11,26,27 Our multivariable linear regression model illustrated that elective admissions, laparoscopic operations, and younger patients were associated with lower hospital stays and total costs.…”

Section: Resultsmentioning

confidence: 99%

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Darbandi¹,

Chopra²

2021

Int J Med Students

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Background: Gallbladder disease confers a significant economic toll on the United States healthcare system. This study aims to characterize current trends and features of the cholecystectomy population and identify factors that influence the length of stay and total charges. Methods: Case information was extracted for laparoscopic and open cholecystectomies from 2013-2016 using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Descriptive, comparative, and multivariable linear regression analysis was conducted on 58,141 cases assessing age group, race, gender, admission presentation, surgical technique, insurance status, year of operation and severity of illness by the length of stay and total charges. Results: Of all procedures, 91.6% were laparoscopic, and 79.4% were emergent on admission. Total procedures trended down, while laparoscopic and emergent cases steadily increased (p<0.0001). Total charges increased during the study period, while the length of stay decreased (p<0.0001). Open and emergent procedures were associated with a higher cost and longer inpatient stays (p<0.0001). Open procedures were proportionally more common among elderly, male patients, and elective cases (p<0.0001). Emergent presentation was more common in females, non-whites, and younger patients (p<0.0001). Regression model showed that male gender, open operation, Black race, and emergent presentation were independent predictors for a longer stay and greater total charges (p<0.0001). Medicare insurance predicted lower total charges but longer length of stay (p<0.0001). Conclusion: Race, insurance, procedure type, and patient presentation influence hospital charges and stays following cholecystectomy. Understanding these trends will allow policymakers and providers to limit the healthcare burden of cholecystectomy.

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“…They found that early intervention was associated with shorter postoperative stay, and no increase in complications rate [17]. Ferrarese et al [18] analyzed the outcome of early and delayed 114 cholecystectomies conducted in their institution. They found laparoscopic cholecystectomy a safe and effective treatment for cholelithiasis and acute cholecystitis in ordinary and emergency settings [18].…”

Section: Operative Management In the Elderlymentioning

confidence: 99%

Gallbladder Disease in the Aged Patient- A Comprehensive Diagnosis and Treatment Approach

Perry¹

2017

ARGH

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The improvements in life expectancy combined with aging of the baby boomer generation will result in a rapid increase in the population older than 65 years in the next few decades, and thus an increase in the need to take care of elderly patients. The authors of this chapter were born and raised in Israel, a country in which due to the holocaust and the fact it was a young nation, was not accustomed to elderly patients. But, in the last decade the percentage of patients older than 65 has crossed the 10% mark of the entire population and we were forced to learn and to find ways to care and treat older patients. As the saying in pediatrics, that a child is not a small adult, the same rule applies seemingly to elderly patients and the know how in treating them is not the same as the 30 years old patient. It is important to do so, because It is expected that by 2030 one in five people will be older than 65 years, with the most rapidly growing segment of this older population being persons older than 85. This number is expected to increase fivefold and reach 20 million by 2050.Gallbladder disease is no stranger to patients of older ages, if at all it even afflicts older patients more. But, older patients suffer from other ailments and physiological derangements which make the diagnosis and treatment of gallbladder diseases harder than in younger patients. The purpose of the current article is the shed some light on the problems and challenges treating and diagnosing gallbladder disease in the elderly, as well as some unique solutions for this age group. We will mainly direct our attention to acute cholecystitis which is very frequent and might be fatal at this age group, which has unique characteristics.

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Elective and emergency laparoscopic cholecystectomy in the elderly: our experience

Cited by 33 publications

References 16 publications

Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis

Gallbladder Disease in the Aged Patient- A Comprehensive Diagnosis and Treatment Approach

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