Outcome after cholecystectomy in the elderly

Heesewijk, Anne E. van; Lammerts, Rosa G. M.; Haveman, Jan-Willem; Meerdink, Mark; Leeuwen, Barbara L. van; Pol, Robert A.

doi:10.1016/j.amjsurg.2018.12.018

Cited by 11 publications

(4 citation statements)

References 27 publications

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“…The mortality in nonagenarians reported in another study was 5.5% and in another series of patients older than 70 years mortality was 6%, both of which are similar to the rate found by us in our study [ 19 , 20 ]. In another series, mortality rate in this age group reached 19.4% [ 21 ].…”

Section: Discussionsupporting

confidence: 91%

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes

et al. 2023

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Background Nonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years. Methods A retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50–69 years, 70–89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien–Dindo scale. Results The patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07–20.13), presence of cholecystitis (RR 8.2 CI95% 1.29–51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10–1.40) were the variables that presented statistically significant differences as risk factors for mortality. Conclusion Cholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

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Section: Discussionsupporting

confidence: 91%

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes

et al. 2023

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“…Laparoscopic cholecystectomy is considered the gold standard for patients with symptoms or complications from gallstones. However, cholecystectomy in older people is associated with higher perioperative complications, prolonged hospital stay, and increased mortality compared to younger adults, which is explained by preexistent comorbidities and reduced physiologic reserve in this age group (van Heesewijk et al 2019;Loozen et al 2017). In patients with acute cholecystitis who are at very-high surgical risk and require an emergent intervention, percutaneous drainage with a cholecystostostomy tube has been the standard of care (Okamoto et al 2018).…”

Section: Gallstonesmentioning

confidence: 99%

Epidemiology of Gastrointestinal Diseases

Machicado

Greer

Yadav

2020

Geriatric Gastroenterology

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“…Recently, some studies have reported poor surgical outcomes for LC in older patients [ 9 , 10 ]. Nevertheless, data on clinical characteristics of the disease and on the surgical outcomes of LC in elderly patients with AC are still lacking.…”

Section: Introductionmentioning

confidence: 99%

Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy

Lee,

Moon

et al. 2023

BMC Gastroenterol

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Background Impact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established. Methods This single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis. Results Of the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3. Conclusion Advanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.

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Outcome after cholecystectomy in the elderly

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Cited by 11 publications

References 27 publications

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes

Laparoscopic cholecystectomy in super elderly (> 90 years of age): safety and outcomes

Epidemiology of Gastrointestinal Diseases

Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy

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