Characteristics and outcome of elderly patients admitted for acute Cholecystitis to medical or surgical wards

Abstract

Background Elderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards. Methods This retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016. Data were retrieved from the electronic health records. Results A total of 187 patients were detected, 54 (29%) in medical departments and 133 (71%) in surgical wards. The mean age (±SD) was 80 ± 7.5 and was higher among those in medical than surgical wards (84 ± 7 versus 79 ± 7, p < 0.05). Patients hospitalized in medical departments had more comorbidity, disability and mental impairment. However, there was no difference in mortality between the two groups, 1 (2%) and 6 (4%) respectively. Independent predictors for hospitalization in medical departments were chronic obstructive pulmonary disease (OR = 9.8, 95% C. I 1.6–59) and the Norton Scale score (NSS)(OR = 0.7, 95% C. I 0.7–0.8). Impaired mental condition was the only predictor for hospitalization > 1 week. The strongest predictor for having cholecystostomy was admission to the surgical department (OR = 14.7, 95% C. I 3.9–56.7). Linear regression showed a negative correlation between NSS and length of hospitalization (LOH; Beta = − 0.5). Conclusion Elderly patients with acute cholecystitis who require conservative management, especially those with severe functional and mental impairment can be safely hospitalized in medical departments. Outcome was not inferior in terms of mortality and LOH. These results have practical policy implications for the placement of elderly patients with acute cholecystitis in medical rather than surgical departments.

Outcomes of Early Vs. Delayed Laparoscopic Cholecystectomy in Acute Biliary Stone-Induced Pancreatitis a Prospective Observational Study

“…(95.83%) was more accurate than Endoscopic Retrograde Cholangiopancreatography (ERCP) (98%) in detecting malignant obstructive jaundice. [19] Similarly, Alam et al spoke about laparoscopic cholecystectomy having a low risk of infection at the port location where the gallbladder was removed. [20] In their research, Rajdev et al recommended laparoscopic cholecystectomy as the primary therapy strategy for patients presenting with cholelithiasis due to benefits such as a shorter hospital stay, aesthetic benefits, and postoperative pain relief.…”

Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department

“…Our finding may result from the fact that we included only patients with documented AAP. Elderly patients might incorrectly identify the pain sensation and location of the pain [ 19 ]. Additionally, some elderly patients mistakenly believe pain is a normal aging process [ 19 ].…”

“…Elderly patients might incorrectly identify the pain sensation and location of the pain [ 19 ]. Additionally, some elderly patients mistakenly believe pain is a normal aging process [ 19 ]. In this study, the accuracy of Murphy’s sign has been debated, with some authors reporting high sensitivity and predictive values [ 20 ].…”

An Investigation into the Predictive Role of Serum Inflammatory Parameters in the Diagnosis of Complicated Acute Cholecystitis

“…Advanced age is a risk factor for AC and most cases occur in the elderly adult population. [ 26 ] Many medical centers prefer to treat elderly patients conservatively and perform delayed cholecystectomy, which they consider safer for this patient group. [ 26 , 27 ] However, if CC develops, there is no doubt that mortality and morbidity will take a more severe dimension, especially in elderly patients.…”

“…[ 26 ] Many medical centers prefer to treat elderly patients conservatively and perform delayed cholecystectomy, which they consider safer for this patient group. [ 26 , 27 ] However, if CC develops, there is no doubt that mortality and morbidity will take a more severe dimension, especially in elderly patients. Therefore, it becomes critical to be able to predict the development of CC in this patient group.…”