2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

Abstract

Background Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.

The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition)

“…Despite the interest in ageing and elderly patients is very high with increasing number of publications about these patients, the concept of "frailty" remains still not clearly defined [98]. Due to a lack of definite criteria and definitions and of well-designed studies in surgical patients with specific including criteria, we decided, according to Pisano et al [99], to adopt a pragmatic definition of an age older than 65 years to define elderly population, according to the job retirement and life expectancy in Italy and western countries; moreover, most of the available studies in literature adopt this definition. The great limitation of this definition is obvious and clear: age alone could not define the frailty of a patient and patients with the same age could be very different for comorbidity and performance status.…”

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

“…It is thus highly relevant to develop the most appropriate care measures and to guide patient-centered decision-making around emergent care [22]. ACCBD is a relatively-frequent diagnosis in patients over 65 years, and while some consensus guidance exists, age is not considered to be a contraindication to operative management [2].…”

“…Snapshot audit, a form of prospective, observational, non-randomised multi-centre cohort study, is a novel methodology for prospective collaborative cohort studies that has allowed detailed, de ned datasets to be accrued in line with a priori analyses stated in pre-publication, open access protocols led with clinical trial repositories [2][3][4] . This methodology, which is superior in some respects to large retrospective registries, has been recently embraced by surgeons as a pragmatic alternative to randomized controlled trial.…”

“…Over the last 25 years, the number of older people undergoing emergency non-cardiac surgical procedures has increased faster than the rate of population ageing. Despite advances in peri-operative care, and changing patient expectations, age and pre-existing comorbidities remain the main predictors of adverse postoperative outcomes in the older surgical population [1][2][3][4][5][6][7][8]. In particular, gallbladder surgery has been highlighted as accruing excess morbidity and mortality in the elderly patient [9].…”

Cholecystectomy for Gallstone: Types and Findings

“…According to the guideline forwarded by Pisano, laparoscopic cholecystectomy should be considered for all; the age, on its own, is not a contraindication for surgery (Pisano et al 2019). While Nassar in his study found that age of the patient is a significant factor determining the likelihood of death and the length of hospital stay after any type of procedure of gallstones removal (Nassar & Richter 2019).…”