Safety of Outpatient Laparoscopic Cholecystectomy in the Elderly: Analysis of 15,248 Patients Using the NSQIP Database

Rao, Ajit; Polanco, Antonio; Qiu, Sujing; Kim, Joseph; Chin, Edward; Divino, Celia M.; Nguyen, Scott Q.

doi:10.1016/j.jamcollsurg.2013.08.001

Cited by 67 publications

(41 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite exclusion of these high-risk patients, the rate of early MACE after LT was nearly 8% in this national sample. This is higher than the early MACE rate after other types of intraabdominal surgery ranging from 0.1% in laparoscopic cholecystectomy(23) to 0.2% after Whipple(24) and is in line with early MACE rates after kidney transplantation, historically the highest risk transplant population for MACE, which ranges from 3.3% to 13.4%(25, 26). The early MACE rate reported in the current study is consistent with previously published single-center studies that have reported MACE rates after LT ranging from 7% to 15%(2, 14, 18).…”

Section: Discussionmentioning

confidence: 52%

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

VanWagner

Serper

Kang

et al. 2016

American Journal of Transplantation

151

161

View full text Add to dashboard Cite

Assessment of major adverse cardiovascular events (MACE) after liver transplantation (LT) has been limited by the lack of a multi-center study with detailed clinical information. An integrated database linking information from the University HealthSystem Consortium and the OPTN was analyzed using multivariate Poisson regression to assess factors associated with 30- and 90-day MACE after LT (2/2002–12/2012). MACE were defined as myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), cardiac arrest, pulmonary embolism and/or stroke. Of 32,810 recipients, MACE hospitalizations occurred in 8% and 11% of patients at 30 and 90 days. Recipients with MACE were older, and more likely to have a history of NASH, alcoholic cirrhosis (ETOH), MI, HF, stroke, AF and pulmonary and chronic renal disease than those without MACE. In multivariable analysis, age > 65 (Incidence rate ratio (IRR)=2.8 (1.8–4.4)), ETOH (IRR=1.6 (1.2–2.2)), NASH (IRR=1.6 (1.1–2.4)), pre-LT creatinine (IRR=1.1 (1.04–1.2)), baseline AF (IRR=6.9 (5.0–9.6)) and stroke (IRR=6.3 (1.6–25.4)) were independently associated with MACE. MACE were associated with lower 1-year survival post-LT (79% vs. 88%, p<.0001). In a national database, MACE occurred in 11% of LT recipients with a negative impact on survival. Pre-LT AF and stroke substantially increase risk of MACE, highlighting potentially high-risk LT candidates.

show abstract

Section: Discussionmentioning

confidence: 52%

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

VanWagner

Serper

Kang

et al. 2016

American Journal of Transplantation

151

161

View full text Add to dashboard Cite

show abstract

“…Despite the exclusion of these high‐risk patients from transplantation, we observed a substantial early post–orthotopic LT CVD mortality rate of 1.2%. For comparison, early CVD mortality after other types of intra‐abdominal surgery ranges from 0.2% (laparoscopic cholecystectomy) to 0.3% (Whipple), and it has been estimated to be as high as 1.7% after coronary artery bypass grafting following acute myocardial infarction . Small single‐center studies during the initial era of LT estimated early post‐LT CVD mortality rates anywhere from 0% to 2.7% .…”

Section: Discussionmentioning

confidence: 99%

“…A preoperative CVD evaluation is undertaken for all potential LT candidates before transplant listing, mainly to screen for significant obstructive coronary artery disease, severe heart failure, and/or severe pulmonary hypertension, which are considered absolute contraindications to LT. 9 Despite the exclusion of these high-risk patients from transplantation, we observed a substantial early post-orthotopic LT CVD mortality rate of 1.2%. For comparison, early CVD mortality after other types of intra-abdominal surgery ranges from 0.2% (laparoscopic cholecystectomy) 18 to 0.3% (Whipple), 19 and it has been estimated to be as high as 1.7% after coronary artery bypass grafting following acute myocardial infarction. 20 Small single-center studies during the initial era of LT estimated early post-LT CVD mortality rates anywhere from 0% to 2.7%.…”

Section: Early Cardiovascular Mortality In the Current Era Of Transplmentioning

confidence: 99%

High early cardiovascular mortality after liver transplantation

et al. 2014

View full text Add to dashboard Cite

Cardiovascular disease (CVD) contributes to excess long-term mortality after liver transplantation (LT), however little is known about early post-operative CVD mortality in the current era. In addition, there is no model to predict early post-operative CVD mortality across centers. We analyzed adult recipients of primary LT in the Organ Procurement and Transplantation Network (OPTN) database between February 2002 and December 2012 to assess prevalence and predictors of early (30-day) CVD mortality, defined as death from arrhythmia, heart failure, myocardial infarction, cardiac arrest, thromboembolism, and/or stroke. We performed logistic regression with stepwise selection to develop a predictive model of early CVD mortality. Sex and center volume were forced into the final model, which was validated using bootstrapping techniques. Among 54,697 LT recipients, there were 1576 (2.9%) deaths within 30 days. CVD death was the leading cause of 30-day mortality (42.1%), followed by infection (27.9%) and graft failure (12.2%). In multivariate analysis, 9 (6 recipient, 2 donor, 1 operative) significant covariates were identified: age, pre-operative hospitalization, ICU and ventilator status, calculated MELD score, portal vein thrombosis, national organ sharing, donor BMI and cold ischemia time. The model showed moderate discrimination (c-statistic 0.66, 95% CI: 0.63–0.68). We provide the first multicenter prognostic model for the prediction of early post-LT CVD death, the most common cause of early post-LT mortality in the current transplant era. However, evaluation of additional CVD-related variables not collected by the OPTN are needed in order to improve model accuracy and potential clinical utility.

show abstract

“…[28] LC is safe in elderly patients, with low morbidity and mortality rates, and perioperative outcomes in elderly patients depend on the severity of gall bladder disease rather than chronologic age. [29] Early LC can be indicated for elderly patients with mild ABP and acceptable morbidity and mortality risks. LC reduces the risk of complications caused by recurrent pancreatitis in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery

Eğin

Yeşiltaş²,

Gökçek³

et al. 2017

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

Safety of Outpatient Laparoscopic Cholecystectomy in the Elderly: Analysis of 15,248 Patients Using the NSQIP Database

Cited by 67 publications

References 24 publications

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample

High early cardiovascular mortality after liver transplantation

Early laparoscopic cholecystectomy following acute biliary pancreatitis expedites recovery

Contact Info

Product

Resources

About