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

Abstract

Introduction: Cholecystectomy is the treatment of choice for symptomatic cholelithiasis. However, outcomes for patients over 80years of age are not well studied. The primary aim of this study was to describe the safety and feasibility of cholecystectomy, including in the acute setting, in a cohort of patients80 years of age. Material and methods: A retrospective study of patients aged80 years submitted to cholecystectomy at a single institution from January 2013 to January 2018 was performed. Severity of acute cholecystitis was graded according to the updated Tokyo Guidelines 18. Early cholecystectomy was defined as being performed within the first 48h after admission and delayed when performed beyond 48h of the admission. Results: In total 316 patients underwent cholecystectomy. The indication was acute cholecystitis in 113 (36%) patients. Of the 316 patients 289 (92%) were attempted laparoscopically and 30 (10%) were converted to open. Major complications occurred in 44 patients (14%) and mortality rate was 4%. No bile duct injuries were observed. For those patients with mild or moderate acute cholecystitis (n = 103), there was no differences in outcomes when comparing early vs delayed surgery. Conclusion: Cholecystectomy in patients80 years of age is safe and feasible. Outcomes did not differ between early and delayed surgery for mild/moderate acute cholecystitis.

Simplified risk stratification in early cholecystectomy for acute cholecystitis based on age: A report from an institution with zero mortality

“…Early LapC for AC patients is associated with a mortality rate of less than 1%, 15 and higher rates ranging from 1.6% to 4.8% are reported from studies based on cohorts above the age of 80 years 16–18 . In the past 9 years, there was no mortality in AC patients receiving early cholecystectomy at our institution, which infers that the decisions on the indication for early surgery, surgical technique, and postoperative care were appropriate.…”

“…Early LapC for AC patients is associated with a mortality rate of less than 1%, 15 and higher rates ranging from 1.6% to 4.8% are reported from studies based on cohorts above the age of 80 years. [16][17][18] In the past 9 years, there was no mortality in AC patients receiving early cholecystectomy at our institution, which infers that the decisions on the indication for early surgery, surgical technique, and postoperative care were appropriate. The aims of this study were (1) to compare the specific characteristics of early LapC for AC between different age groups, (2) to identify predictive risk factors of postoperative complications for each group, and (3) to build a new, simpler riskassessment system.…”

“…Mortality rates of early LapC in AC patients have been reported to be less than 1%, 15 and higher rates ranging from 1.6% to 4.8% were observed in studies based on cohorts above the age of 80 years. [16][17][18] Our selection of patients indicated for early surgery was influenced by TG18, which enabled us to exclude 26 patients from early surgery for the reasons shown in Figure S1. In particular, we have avoided early surgery in patients with jaundice, neurological dysfunction, or respiratory failure, since they are associated with increased mortality rates.…”

Seguridad de la colecistectomía laparoscópica en pacientes mayores de 90 años en un hospital privado en Ecuador: una serie de casos

“…Despite that, laparoscopic cholecystectomy is currently considered the gold standard in the treatment of acute cholecystitis in the elderly 6 . Laparoscopic cholecystectomy can be safely performed in many patients of up to 85 years, as previously demonstrated 7 . However, the optimal management of acute cholecystitis in patients older than 90 years is less clear.…”

Clinical Profile and Evaluation of Outcomes of Symptomatic Gallstone Disease in the Senior Citizen Population

“…Moreover, for this reason, there were increased chances of complications, conversion rate, and increased use of drains in the surgery. A study by Serna concluded that there is no difference in early cholecystectomy and interval cholecystectomy outcomes in cases of mild to moderate acute cholecystitis [ 24 ]. A study by Fuks went on further to conclude that the outcomes of early cholecystectomy in patients less than the age of 75 years had a similar result compared to patients more than 75 years of age [ 25 ].…”