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

Abstract

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.

Systematic review of the role of indocyanine green near‑infrared fluorescence in safe laparoscopic cholecystectomy (Review)

“…They are also one of the main causes of allegations of malpractice in biliary surgery. The main risk factors for BDI are the severity of the inflammatory process in acute cholecystitis (AC), fibro-sclerosing remodeling associated with chronic inflammation, and the anatomical variability of the bile duct, which are also risk factors for conversion to open surgery (4). Postoperative adhesions are the leading cause of conversion from laparoscopy to laparotomy (5).…”

Anaesthesia Concern in High-Risk Cases Under-Going Ambulatory Laparoscopic Cholecystectomy

“…In other studies, they patients with gall stones and acute cholecystitis attack the management was guided on basis of symptoms severity. ASA class, CCI index (Tokyo Guidelines severity risk scale grading) planned for laparoscopic cholecystectomy need to be done at a tertiary care setup with support of functional intensive care after full peri-operative optimization and these patients cannot be discharged on same day of procedure 20,21,22 . Early surgical laparoscopic cholecystectomy for acute cholecystitis cases even with medical diseases is the approach recommended in another study 23,24 .…”

A Prospective Observational Study of 42 Patients with COVID-19 infection and a History of Hepatitis C Virus Infection and Thyroid Disease with Follow-Up Thyroid Function and Autoantibody Testing

“…Modern interferon-free therapies in HCV infection, which are associated with high cure rates and few adverse reactions, are expected to reduce the rate and severity of HCV extrahepatic manifestations [ 40 – 43 ]. It appears that HCV-associated thyroid disorders can persist after all oral antiviral therapy but are less frequent and severe than after the classical interferon-based regimens [ 44 , 45 ]. Our findings regarding COVID-19 consequences among HCV-infected patients with preexistent thyroid dysfunction are comparable with those described by other recent studies (that included patients without known HCV-induced thyroidal dysfunction) [ 46 ].…”