Geriatric Assessment as a qualification element for elective and emergency cholecystectomy in older patients

Abstract

BackgroundOlder patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients. However, most studies have not considered patient frailty, particularly regarding emergency cholecystectomy. The aim of this prospective study was to evaluate outcomes in frail older patients eligible for elective and emergency cholecystectomy.MethodsPreoperative Geriatric Assessment (GA) was performed in consecutive patients aged 65+ years, operated for biliary disease. The GA evaluated the functional, cognitive, comorbidity, depressive, nutritional, and polypharmacy status and patients with two or more abnormal domains were considered frail. Outcomes of interest were 30-day postoperative mortality, morbidity, and length of hospital stay (LOS).ResultsA total of 126 patients (median age 74; range 65–93 years) were included. There was no difference between elective frail and non-frail patients regarding postoperative mortality (0 %) and morbidity (6 % vs. 5 %; p = 0.76). LOS was not significantly longer in the frail group (5.6 vs. 4 days; p = 0.22). In the emergency-admitted patients, almost all complications occurred in the frail population (mortality 5 % vs. 0 %; morbidity 36.7 % vs. 3.3 %, compared with non-frail patients, respectively; p < 0.01) and LOS was significantly longer (10.3 (frail) vs. 6 days (non-frail);p = 0.03). Frail status was a significant independent predictive factor for postoperative complications in the emergency population, only (odds ratio: 3.4 (1.2–9.7); p = 0.02).ConclusionsElective laparoscopic cholecystectomy is a safe and effective surgical technique also for older frail patients. In emergency settings, frail patients have significantly more complications and a longer LOS. However, the role of severity of frailty and the most reliable GA tools require further study.Trial registrationISRCTN14976998 (retrospectively registered)

Indications for Emergency Abdominal Surgeries in Older Patients: 7-Year Experience of a Single Centre

“…Many surgeons hesitate to operate on older patients with symptomatic cholelithiasis. However, we have shown in our previous study that elective laparoscopic cholecystectomy, in experienced hands, is safe, even in frail older patients, and can be performed with minor morbidity and no mortality [19].…”

Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

“…Secondly, chronological age has many limitations and data on biological fitness is lacking to explain why elderly patients develop poorer outcomes compared to younger patients [32]. For example, prospective scoring of patient frailty, an increasingly recognised feature associated with poor postoperative outcomes, is lacking [7,33]. Thirdly, a precise scoring of intraoperative cholecystectomy difficulty is lacking [34,35].…”

Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients

“…[2][3][4]14,15 Despite these results, and in accordance with the present study, large series of elderly patients submitted to cholecystectomy have been published with favorable results in terms of morbidity and mortality (ranging from 0.2% to 22%) 3, [14][15][16] demonstrating that preoperative morbidity factors played a much more relevant role in terms of survival than age itself. 11,16,17 The circumstances of surgery are relevant, as demonstrated by Nielsen et al and others, with a reported 63% of uneventful postoperative course when cholecystectomy was performed electively. 3,11,18 Moreover, urgent surgery was identified in the current study, as a poor prognostic factor for octogenarians undergoing cholecystectomy.…”