Evolution in the management of acute cholecystitis in the elderly: population-based cohort study

Wiggins, Tom; Markar, Sheraz R.; Mackenzie, Hugh; Jamel, Sara; Askari, Alan; Faiz, Omar; Karamanakos, Stavros

doi:10.1007/s00464-018-6092-5

Cited by 52 publications

(46 citation statements)

References 37 publications

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“…In older patients and patients with underlying diseases, LC after PTGBD, with preoperative assessment may reduce the risk of surgery. A recent meta-analysis also supports this result 30…”

Section: Discussionsupporting

confidence: 58%

“…There are limitations to such research, because surgeons choose the healthiest cohort of elderly patients with AC for LC 29. A recent cohort study reported better outcome for elderly patients with LC compared with patients who did not undergo surgery,30 but a possibility of selection bias still exists. In this study, instead of comparing the results according to whether or not surgery is performed on older patients, comparisons were made according to age.…”

Section: Discussionmentioning

confidence: 99%

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

Shin

Park

2018

Ann Hepatobiliary Pancreat Surg

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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.

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“…In older patients and patients with underlying diseases, LC after PTGBD, with preoperative assessment may reduce the risk of surgery. A recent meta-analysis also supports this result 30…”

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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

Shin

Park

2018

Ann Hepatobiliary Pancreat Surg

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“…The increased mortality con rms the frailty of elderly people and re ects the results of studies taking the emergency abdominal surgery in the elderly under the scope. These are showing a higher mortality of 8-16% in this group even being treated [18][19][20]. Just to re ect the COVID Situation during our examined period, the total number of COVID positive deaths in Austria was 384 and 27 in whole State Salzburg, Austria [21,22].…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 pandemic Lockdown on the utilization of acute surgical care, retrospective, multicenter analysis

Presl

Varga

et al. 2020

Preprint

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Background: The emergency general surgery encompasses the care of critically ill patients, with a potentially high mortality if delayed. As some medical disciplines have reported a strong decrease of emergencies during the COVID-19 pandemic, remains the effect of the Lockdown on the general surgery emergencies unclear. Methods:This study is a retrospective, multicentre analysis of the general surgery emergency operations performed during the 2020 Lockdown and in the same period of 2019 in three centers covering the surgical care of the area Salzburg-North, Austria. Results: In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in Year 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 Lockdown (p=0.005). The average length of hospital stay in the 2019 was in median 4 days and was reduced to 3 days during the Lockdown. Appendectomy remained the most performed emergency surgery for the both periods but the operations count reduced to less than a half with 72 cases in 2019 and 33 cases in 2020 (p=0.118). Considering the ration of appendectomy vs all emergency surgeries, it represented 25 % in 2019 and 20% in 2020. The emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. A strongest reduction in frequency of 6 of 13 main categories of emergency surgeries was reported from Center 1, which was the only COVID designed Center (“Hot” hospital) in the examined region.Conclusions:The emergency general surgery is an essential service that continues to run under any circumstances. Our data showed that the COVID-19 related restriction and the fear of being infected with COVID-19 in the hospital result in a significant decrease of the utilization of acute surgical care. Policies and modern alternatives are needed to ensure continued access to specialized services to prevent patients from harm.

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“…While the work-up algorithm for AC in the general population is relatively clear, 6 for the geriatric population it remains controversial and in the large published series to date, the vast majority of octogenarians with AC receive conservative treatment. 19 Urgent surgery for acute cholecystitis in octogenarians has been associated in the literature with increased rates of primary open (47%) and laparoscopicconverted surgeries (with conversion rates ranging from 7 to 36%). 4,13,15 In the present study, the conversion rate in AC was 19% and only 15% of surgeries for AC were performed open.…”

Section: Discussionmentioning

confidence: 99%

Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients

Serna

Ruano

Pérez-Jiménez

et al. 2019

HPB

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Introduction: Cholecystectomy is the treatment of choice for symptomatic cholelithiasis. However, outcomes for patients over 80years of age are not well studied. The primary aim of this study was to describe the safety and feasibility of cholecystectomy, including in the acute setting, in a cohort of patients80 years of age. Material and methods: A retrospective study of patients aged80 years submitted to cholecystectomy at a single institution from January 2013 to January 2018 was performed. Severity of acute cholecystitis was graded according to the updated Tokyo Guidelines 18. Early cholecystectomy was defined as being performed within the first 48h after admission and delayed when performed beyond 48h of the admission. Results: In total 316 patients underwent cholecystectomy. The indication was acute cholecystitis in 113 (36%) patients. Of the 316 patients 289 (92%) were attempted laparoscopically and 30 (10%) were converted to open. Major complications occurred in 44 patients (14%) and mortality rate was 4%. No bile duct injuries were observed. For those patients with mild or moderate acute cholecystitis (n = 103), there was no differences in outcomes when comparing early vs delayed surgery. Conclusion: Cholecystectomy in patients80 years of age is safe and feasible. Outcomes did not differ between early and delayed surgery for mild/moderate acute cholecystitis.

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Evolution in the management of acute cholecystitis in the elderly: population-based cohort study

Cited by 52 publications

References 37 publications

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

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

The Impact of COVID-19 pandemic Lockdown on the utilization of acute surgical care, retrospective, multicenter analysis

Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients

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