Acute cholecystitis in the elderly

The population of Finland is ageing fast, and acute cholecystitis is common among elderly people. Because the treatment options have changed greatly since the late 1980's, we wanted to find out whether the active treatment policy nowadays used in our hospital has some effects on operability, morbidity, mortality and the duration of the in-patient period. The numerous serious illnesses of elderly people that cause considerable morbidity and mortality underlines the importance of risk stratification, and clinical variables were therefore also tested for their ability to predict the probability of morbidity and mortality.

Two hundred and eighteen patients aged over 75 years, 92 patients during the 5-year period 1988-1992 (Period I) and 126 patients during the 5-year period 1998-2002 (Period II) had been admitted into our hospital for acute cholecystitis, and they were identified from a computer database. During these two periods, different treatment strategies were used. The clinical data were reviewed from the database and the patient records.

The active use of ERCP and percutaneous cholecystostomy during Period II decreased the number of all operations and emergency operations. Only six of the 43 patients who underwent early cholecystostomy were later scheduled for cholecystectomy. Postoperative morbidity did not differ between the two periods, and stepwise logistic regression analysis showed obesity to be an independent predictor of morbidity. Overall mortality was 8% during period I and 6% during period II, and of the clinical variables, underlying lung disease, malnutrition, pericholecystic fluid collection in ultrasound and perforation of the gallbladder were independent predictors of mortality in stepwise logistic regression analysis. Neither the primary in-patient period nor the total in-patient period were significantly shorter during Period II.

Active treatment of acute cholecystitis in the elderly may decrease the need for emergency surgery. Malnutrition and perforation of the gallbladder are the most important predictors of mortality in this patient group.