Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly: a systematic review and meta-analysis

Lord, Amy; Hicks, Georgina; Pearce, Belinda; Tanno, Lulu; Pucher, Phil

doi:10.1080/00015458.2019.1658356

Cited by 17 publications

(15 citation statements)

References 36 publications

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“…Moreover, the multivariate analysis showed that severe inflammation (gangrenous cholecystitis) and comorbidities such as diabetes, previous stroke and chronic renal and pulmonary disease, but not age itself, are risk factors for postoperative morbidity. This finding is also communicated by Kim et al [ 46 , 47 ]. Moreover, Agrusa et al recommended elective laparoscopic surgery in elderly people with symptomatic gallstone disease before the development of acute cholecystitis and related complications [ 48 ].…”

Section: Discussionsupporting

confidence: 86%

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

et al. 2021

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Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50–64 years; C: 65–79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50–64 years, 65–79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.

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Section: Discussionsupporting

confidence: 86%

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

et al. 2021

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“…In the past decades, cholecystectomy has become one of the most frequently performed surgical procedures, both in the elective and in the urgency/emergency setting (1). The laparoscopic approach is now the first choice and in most cases, it allows to complete the surgical procedure with excellent patient outcomes, adding the laparoscopic advantages in terms of postoperative management (2)(3)(4). The usefulness of surgical drain placement after a cholecystectomy has long been debated.…”

Section: Introductionmentioning

confidence: 99%

“…However, it still remains a device used in conditions that often raise serious concerns about its usefulness or even raise doubts about its potentially harmful effects. These considerations are particularly relevant for patients who are more fragile for clinical and age-related reasons, such as the elderly (4,14). To date, the evidence of the non-beneficial effect of the surgical drain comes from studies with a heterogeneous population (5,6,15,16).…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Drain Placement After Laparoscopic Cholecystectomy

et al. 2022

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PurposeCurrently, surgical drainage during a laparoscopic cholecystectomy (LC) is still placed in selected patients. Evidence of the non-beneficial effect of the surgical drain comes from studies with a heterogeneous population. This preliminary study aims to identify any clinical, demographic, or intraoperative predictive factors for a surgical drain placement during LC as the first step to identify population for a prospective randomized study.MethodThe study was conducted in a single referral center and academic hospital between 2014 and 2018. Patients who underwent unconverted LC were divided into two groups: Group A (drain) and Group B (no drain). We explored baseline, preoperative, intraoperative characteristics, and postoperative outcomes.ResultsBetween 409 patients who underwent LC: 90 (22%) patients were in Group A (drain). Age >64 years, male sex, cholecystitis, Charlson comorbidity index (CCI) ≥ 1, experienced surgeon, intraoperative technical difficulties, need for an additional trocar, operative time >60 min, and estimated blood loss >10 ml were predictive factors at univariate analysis. While at multivariate analysis, cholecystitis (odds ratio [OR]: 2.8, 95% CI:1.5–5.1; p < 0.001), CCI ≥ 1 (OR:1.9, 95% CI:1.0–3.5; p = 0.05), intraoperative technical difficulties (OR: 3.6, 95% CI:1.8–6.2; p < 0.001), need of an additional trocar (OR: 2.5, 95% CI: 1.4–4.4; p < 0.005), and estimated blood loss >10 ml (OR: 3.0, 95% CI:1.7–5.3; p < 0.0001) were predictive factors for a surgical drain placement during LC.ConclusionsThis study identified predictive factors that currently drive the surgeons to a surgical drain placement after LC. Randomized prospective studies are needed to define the use of drain placement in these selected patients.

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“…The incidence of gallstones in those aged 80 or over is as high as 38%-53%, and it could increase up to 80% for patients over 90 years of age[ 3 - 5 ]. After an initial episode of biliary colic, 20%-40% of patients will experience recurrent episodes[ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study

D’Acapito¹,

Solaini²,

Pietrantonio³

et al. 2022

WJCC

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BACKGROUND Incidence of gallstones in those aged ≥ 80 years is as high as 38%-53%. The decision-making process to select those oldest old patients who could benefit from cholecystectomy is challenging. AIM To assess the risk of morbidity of the “oldest-old” patients treated with cholecystectomy in order to provide useful data that could help surgeons in the decision-making process leading to surgery in this population. METHODS A retrospective study was conducted between 2010 and 2019. Perioperative variables were collected and compared between patients who had postoperative complications. A model was created and tested to predict severe postoperative morbidity. RESULTS The 269 patients were included in the study (193 complicated). The 9.7% of complications were grade 3 or 4 according to the Clavien-Dindo classification. Bilirubin levels were lower in patients who did not have any postoperative complications. American Society of Anesthesiologists scale 4 patients, performing a choledocholithotomy and bilirubin levels were associated with Clavien-Dindo > 2 complications ( P < 0.001). The decision curve analysis showed that the proposed model had a higher net benefit than the treating all/none options between threshold probabilities of 11% and 32% of developing a severe complication. CONCLUSION Patients with American Society of Anesthesiologists scale 4, higher level of bilirubin and need of choledocholithotomy are at the highest risk of a severely complicated postoperative course. Alternative endoscopic or percutaneous treatments should be considered in this subgroup of octogenarians.

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Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly: a systematic review and meta-analysis

Cited by 17 publications

References 36 publications

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

Predictive Factors for Drain Placement After Laparoscopic Cholecystectomy

Which octogenarian patients are at higher risk after cholecystectomy for symptomatic gallstone disease? A single center cohort study

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