Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans

Kuy, SreyRam; Sosa, Julie Ann; Roman, Sanziana A.; Desai, Rani A.; Rosenthal, Ronnie A.

doi:10.1016/j.amjsurg.2010.04.018

Cited by 75 publications

(58 citation statements)

References 18 publications

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“…These factors have been associated with health care costs in previous research. 4,[20][21][22][23][24] Even after truncating the data, the data continued to be right-skewed. The cost data were logarithmically transformed to adjust for the skewness.…”

Section: Discussionmentioning

confidence: 99%

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

Bailey

Davis

Levy

et al. 2016

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Background: Postoperative complications have been identified as an important and potentially preventable cause of increased hospital costs. While older adults are at increased risk of experiencing complications and other adverse events, very little research has specifically examined how these events impact inpatient costs. We sought to examine the association between postoperative complications, hospital mortality and loss of independence and direct inpatient health care costs in patients 70 years or older who underwent nonelective abdominal surgery. Methods:We prospectively enrolled consecutive patients 70 years or older who underwent nonelective abdominal surgery between July 1, 2011, and Sept. 30, 2012. Detailed patient-level data were collected regarding demographics, diagnosis, treatment and outcomes. Patient-level resource tracking was used to calculate direct hospital costs (2012 $CDN). We examined the association between complications, hospital mortality and loss of independence cost using multiple linear regression.Results: During the study period 212 patients underwent surgery. Overall, 51.9% of patients experienced a nonfatal complication (32.5% minor and 19.4% major), 6.6% died in hospital and 22.6% experienced a loss of independence. On multivariate analysis nonfatal complications (p < 0.001), hospital mortality (p = 0.021) and loss of independence at discharge (p < 0.001) were independently associated with health care costs. These adverse events respectively accounted for 30%, 4% and 10% of the total costs of hospital care. Conclusion:Adverse events were common after abdominal surgery in older adults and accounted for 44% of overall costs. This represents a substantial opportunity for better patient outcomes and cost savings with quality improvement strategies tailored to the needs of this high-risk surgical population.Contexte : Les complications postopératoires sont une cause évitable qui contribue grandement aux coûts hospitaliers élevés. Malgré le fait que les personnes âgées courent un risque accru de subir des complications ou des événements indésirables, peu de recherches ont étudié l'incidence de ces éléments sur les coûts d'hospitalisation. Nous nous sommes penchés sur la relation entre les coûts des soins de santé assumés par les malades hospitalisés et les complications postopératoires, la mortalité hospitalière et la perte d'autonomie auprès d'une population de patients de 70 ans et plus ayant subi une intervention chirurgicale abdominale non facultative.Méthodes : La cohorte prospective a été formée de patients consécutifs âgés de 70 ans et plus ayant subi une intervention chirurgicale abdominale non facultative entre le 1 er juillet 2011 et le 30 septembre 2012. Des données détaillées concernant leur profil démographique, leur diagnostic, leur traitement et leurs résultats ont été recueillies. Le calcul des coûts hospitaliers directs est basé sur un suivi des ressources utilisées par les patients (en dollars canadiens, 2012). Au moyen d'une régression linéaire multiple, nous avons an...

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Section: Discussionmentioning

confidence: 99%

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

Bailey

Davis

Levy

et al. 2016

cjs

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“…The prevalence of gallstones increases with age in both sexes and in nearly all populations; in older individuals the prevalence ranges from 20% to 30% and increases to 80% for institutionalized patients older than 90 years [1,2,3]. Since the introduction of laparoscopic cholecystectomy (LC) nearly two decades ago, and the more recent use of it as an outpatient procedure, many surgeons now view cholecystectomy as a relatively simple procedure from which patients recover quickly [4]. Cholecystectomy for symptomatic gallstone disease is more common in elderly patients as the incidence of gallstones increases with age [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

Lee

Yoo

et al. 2015

Ann Surg Treat Res

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PurposeExtremely elderly patients who present with complicated gallstone disease are less likely to undergo definitive treatment. The use of laparoscopic cholecystectomy (LC) in older patients is complicated by comorbid conditions that are concomitant with advanced age and may increase postoperative complications and the frequency of conversion to open surgery. We aimed to evaluate the results of LC in patients (older than 80 years).MethodsWe retrospectively analyzed 302 patients who underwent LC for acute cholecystitis between January 2011 and December 2013. Total patients were divided into three groups: group 1 patients were younger than 65 years, group 2 patients were between 65 and 79 years, and group 3 patients were older than 80 years. Patient characteristics were compared between the different groups.ResultsThe conversion rate was significantly higher in group 3 compared to that in the other groups. Hematoma in gallbladder fossa and intraoperative bleeding were higher in group 3, the difference was not significant. Wound infection was not different between the three groups. Operating time and postoperative hospital stay were significantly higher in group 3 compared to those in the other groups. There was no reported bile leakage and operative mortality. Preoperative percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography were performed more frequently in group 3 than in the other groups.ConclusionLC is safe and feasible. It should be the gold-standard approach for extremely elderly patients with acute cholecystitis.

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“…Of the group of patients studied, we observed a predominance of the female gender, remembering that gallstones are more prevalent in females 5,9 . Regarding surgical risk, we found a predominance of individuals with comorbidities in group II.…”

Section: Sd: Standard Deviation; * Student T Test Comparison Of Meansmentioning

confidence: 91%

“…Cholelithiasis is the most common abdominal surgical disease in these individuals 5 and several studies describe the increase of cholecystectomies in octagenarians [6][7][8] . The high prevalence of cholelithiasis makes cholecystectomy one of the most performed surgical procedures in the world 9,10 .…”

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confidence: 99%

Comparative study of systemic early postoperative inflammatory response among elderly and non-elderly patients undergoing laparoscopic cholecystectomy

Fialho

Cunha-e-Silva

Santa-Maria

et al. 2018

Rev. Col. Bras. Cir.

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Objective: to evaluate and compare the early postoperative period systemic inflammatory response between elderly and non-elderly patients submitted to laparoscopic cholecystectomy, mainly performing a quantitative analysis of interleukin-6 (IL-6), a marker of inflammatory activity systemic. Methods: we compared a series of cases over a period of six months at the Gaffrée and Guinle University Hospital of the Federal University of the State of Rio de Janeiro, involving 60 patients submitted to elective laparoscopic cholecystectomy. We used non-probabilistic sampling for convenience, selecting, from the inclusion criteria, the first 30 patients aged 18-60 years, who comprised group I, and 30 patients with age equal to or greater than 60 years, who formed group II. Results: the 60 patients involved were followed for at least 30 days after surgery and there were no complications. There was no conversion to open surgery. The values of the medians found in the IL-6 dosages for the preoperative period, three hours after the procedure and 24 hours after surgery were, respectively, 3.1 vs. 4.7 pg/ml, 7.3 vs. 14.1 pg/ml and 4.4 vs 13.3 pg/ml. Conclusion: Elderly patients were more responsive to surgical trauma and had elevated IL-6 levels for a longer period than the non-elderly group.

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Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans

Cited by 75 publications

References 18 publications

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

Comparative study of systemic early postoperative inflammatory response among elderly and non-elderly patients undergoing laparoscopic cholecystectomy

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