Management of complicated gallstones in the elderly: comparing surgical and non-surgical treatment options

Abstract

Objective The aim of this study was to evaluate the differences in clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP), ERCP followed by cholecystectomy (EC) and percutaneous aspiration (PA) in the elderly population with choledocholithiasis. Methods We included a total of 43 338 elderly patients aged 60 years or older and 45 295 patients younger than 60 years for comparison in our study. Data were obtained from the Nationwide Inpatient Sample (Healthcare Utilization Project) for years 2001–14 by identifying patients who were admitted for gallstone complications based on the ICD 9 diagnostic code. Multiple logistic regression was used to calculate the odds of in-hospital mortality and to detect statistical differences among the treatment groups, age groups and between male and female patients. Univariate ordinary linear regression was used to compare the length of hospital stay and readmission frequency among the different age groups. Results The age of the patient affected mortality and the length of hospital stay after any type of procedure of gallstones removal. In a manner independent of the patient’s age, PA was associated with the highest risk of death and length of stay, while the EC was characterized by lowest mortality and ERCP by the shortest length of stay. Neither age of the patient nor the type of procedure affected the likelihood of readmission. The odds of death and the probability of readmission were not affected by patient sex. However, in patients aged between 60 and 79 years, the female gender predicted a shorter duration of stay in the hospital. Conclusions A patient’s age negatively affects the treatment outcomes of cholelithiasis with associated complications. The EC procedure appears to be the method of choice for the management of complicated gallstones in patients of all ages.

Positive correlation between pancreatic volume and post‐endoscopic retrograde cholangiopancreatography pancreatitis

“…In the present study, age was not the risk factor of PEP. However, in the comparison between elderly patients aged 60 years or older and younger than 60 years, younger than 60 years group was significantly a larger pancreatic volume . Thus, younger age may increase the incidence of PEP.…”

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). Laparoscopic and open cholecystectomy were used for our patients in this study, with a conversion from laparoscopic to open procedure at a rate of 2.5%.…”

Role of ERCP in the Older Adults

“…However, in patients with a history of cholecystectomy, ERCP is the preferred method for removing bile duct stones. A retrospective study comparing 43,338 older patients (60 years) with 45,295 younger patients (<60 years) from the Nationwide Inpatient Sample database suggested that ERCP followed by cholecystectomy was characterized by lowest mortality among the older patients and should be the preferred method of management for patients with complicated gallstone disease, regardless of the age (Nassar and Richter 2019). However, in this study, although mortality was found to be significantly higher in ERCP compared to ERCP followed by cholecystectomy in patients 60-79 years old, death rates were noted to be comparable between the two groups in patients more than 80 years old.…”