Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly

A study was conducted to determine whether extremely elderly patients, age 80 years or older, were at higher risk for adverse outcomes from laparoscopic cholecystectomy than patients younger than 80 years.

Laparoscopic cholecystectomy was attempted in 421 patients age 65 years or older from 1989 through 1999. The patients were divided into two groups: group 1 (age 65-79 years; n = 351) and group 2 (age, 80-95 years; n = 70). A prospective database was analyzed for mean +/- standard deviation and using Student's t-test and chi-square analysis.

Advanced age (group 2) was associated with a higher mean American Society of Anesthesiology (ASA) class (2.7 vs 2.3; p < 0.001) and a greater incidence of common bile duct stones (43% vs 26%; p < 0.01), as compared with those of younger age (group 1). Mean operative times in group 2 were 106 +/- 45 min as compared with 96 +/- 38 min in group 1, a difference that is not significant. The extremely elderly (group 2) had a four-fold higher rate of conversion to open cholecystectomy (16% vs 4%) and a longer mean postoperative hospital stay (2.1 vs 1.4 days). Grades 1 and 2 complications also were more common in group 2: grade 1: group 1, 8.8% vs group 2, 17% and grade 2: group 1, 4.3% vs group 2, 7.1% (p < 0.05). One patient in group 1 had a myocardial infarction 13 days postoperatively, and two deaths occurred in the extremely elderly group within 30 days postoperatively.

Laparoscopic cholecystectomy in the extremely elderly is associated with more complications and a higher rate of conversion to open cholecystectomy than in elderly individuals younger than 80 years. The greater chance of encountering a severely inflamed or scarred gallbladder and common bile duct stones as well as increasing comorbidities likely account for these differences in outcome.