Key result
Age ≥80 years was associated with higher overall complications (25% vs. 9%; P=0.03) after cholecystectomy for acute cholecystitis, but was not an independent risk factor on multivariate analysis.
Why the study?
Surgical operations in elderly patients are increasing with population aging, prompting an investigation into peri-operative outcomes of octogenarians undergoing cholecystectomy for acute cholecystitis.
Does advanced age (≥80 years) worsen peri-operative outcomes in patients undergoing cholecystectomy for acute cholecystitis?
Cohort (n=464)
Yes
Does advanced age (≥80 years) worsen peri-operative outcomes in patients undergoing cholecystectomy for acute cholecystitis?
Absolute Event Rate: 25% vs 9%
p-value: p=0.03
Cholecystectomy for acute cholecystitis in octogenarians is relatively safe, as age >80 is not an independent risk factor for postoperative morbidity and mortality despite higher crude complication rates.
Age alone should not preclude cholecystectomy in acute cholecystitis; leaves open whether comorbidities drive complications in patients ≥80 years.
BACKGROUND: The number of surgical operations in elderly patients is increasing due to the aging demographics of western populations. The aim of the present study was to investigate the peri-operative outcome of octogenarian patients undergoing cholecystectomy for acute cholecystitis. METHODS: We performed a retrospective analysis including all patients who underwent cholecystectomy for acute cholecystitis from January 2013 to December 2017. Records were collected prospectively from two centers: 1) Unit of Emergency Surgery, St. Orsola University Hospital, Alma Mater Studiorum University, Bologna; 2) "Advanced Surgical Technologies" Department of Surgical Sciences, Umberto I University Hospital, La Sapienza University, Rome. Patients were divided by age (≥ or <80 years) and peri-operative outcomes were compared. RESULTS: During the study period, 464 patients were operated for acute cholecystitis in the two centers. Sixty-three (14%) patients were octogenarians (group 1) and median age was 84.8±3.9 years. Four hundred and one patients (86%) were younger than 80 years (group 2) with median age of 55.3±15.3 years. Forty-four per cent of group-1 patients underwent laparoscopic cholecystectomy versus 81% of the younger group (P<0.01). Elderly patients had a higher percentage of overall complications (25% vs. 9%; P=0.03) and a longer median postoperative length of stay (7.2±6.8 vs. 4.6±7.7; P=0.04). Overall mortality was 1%: two patients died in group-1 and one in group-2 (P=0.50). However, on multivariate analysis age older than 80 years was not found to be an independent risk factor for postoperative morbidity and mortality. CONCLUSIONS: The results of this study suggest that cholecystectomy for acute cholecystitis in octogenarians is a relatively safe procedure with an acceptable risk of complications and a postoperative hospital stay comparable to younger ones.
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Vaccari et al. (2019) conducted a cohort in Acute cholecystitis (n=464). Age ≥80 years vs. Age <80 years was evaluated on Overall complications (p=0.03). Age ≥80 years was associated with higher overall complications (25% vs. 9%; P=0.03) after cholecystectomy for acute cholecystitis, but was not an independent risk factor on multivariate analysis.