Complications of laparoscopic cholecystectomy in a geriatric population group

The purpose of this study was to assess the complications of laparoscopic cholecystectomy among geriatric patients in New York State who receive their medical care under the Federal Medicare Program. A 20% random sample survey (304 patients) of the 1,520 patients who underwent laparoscopic cholecystectomy between January 1, 1990, and June 30, 1991, was selected. Coded ICD-9 diagnoses and procedures were carefully reviewed for these patients. In some patients with complications, the medical charts were reviewed by a medical epidemiologist and a surgeon to more fully elucidate the reported complications. The patients in this study were randomly selected from public, proprietary, voluntary, and teaching hospitals. Seventy-two complications (23.68% of the 304 patients) were identified in 48 patients (15.78% of the 304 patients). Of these complications, 27 (8.88%) were surgical, and 43 (14.14%) were medical in character. There were two deaths (0.66% of the 304 patients). Individual chart review of 32 of the 48 cases with complications revealed physician-related surgical quality-of-care problems which directly contributed to complications in 10 patients (31.25%). The overall complication rate of 23.68% found in this study represents one of the highest so far reported among published studies of laparoscopic cholecystectomy. The results of this study indicate a significant level of morbidity when laparoscopic cholecystectomy is performed on a geriatric population group. Although age-associated risk factors contributed to this high complication rate, so too did errors of surgical judgment and technique.(ABSTRACT TRUNCATED AT 250 WORDS)