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Laparoscopic cholecystectomy for acute calculous cholecystitis in elderly. More complex but equally safe and
Insights
Laparoscopic cholecystectomy is safe for elderly patients with acute calculous cholecystitis (ACC), but may lead to longer hospital stays. Common bile duct stones increase morbidity risk in this population.
Area of Science:
- Surgical Gastroenterology
- Geriatric Surgery
- Minimally Invasive Surgery
Background:
- Acute calculous cholecystitis (ACC) is a common condition in the elderly.
- Laparoscopic cholecystectomy is the standard treatment for ACC, irrespective of patient age.
- Assessing the safety and efficacy of laparoscopy in different elderly age groups is crucial.
Purpose of the Study:
- To compare outcomes of laparoscopic cholecystectomy across distinct elderly age groups (70-75, 76-80, >80 years).
- To evaluate the safety and effectiveness of laparoscopy in elderly patients compared to younger cohorts.
- To identify predictive factors for postoperative morbidity in elderly ACC patients.
Main Methods:
- Prospective enrollment of patients aged 70+ undergoing laparoscopic cholecystectomy for ACC from 2010-2020.
- Categorization into three age groups: 70-75, 76-80, and >80 years.
- Comparison of demographic data, intraoperative variables, and postoperative outcomes, including major complications (Clavien-Dindo grade > II) and multivariate analysis for morbidity predictors.
Main Results:
- A total of 832 patients were analyzed; 302 were aged 70 and above.
- Higher ASA and CACI scores were observed in the >80 group.
- Conversion to open surgery rates were higher in the 70-75 and >80 groups. The >80 group had a higher incidence of common bile duct stones (31.7%) and longer hospital stays.
- Age >80 and common bile duct stones were identified as significant predictors of postoperative morbidity.
Conclusions:
- Laparoscopic cholecystectomy is a safe procedure for elderly patients with ACC.
- Elderly patients, particularly those over 80, may experience longer postoperative hospital stays.
- The presence of common bile duct stones is associated with an increased risk of morbidity in this patient population.
Aim:
Acute calculous cholecystitis (ACC) is one of the most common pathologies in the elderly. Laparoscopy is the gold standard for ACC treatment, regardless of age. This study aimed to compare different classes of elderly patients affected by ACC and assess whether laparoscopy has the same safety and effectiveness as younger patients.
Materials And Methods:
Patients aging ≠ 70 y-o presenting with ACC treated with laparoscopic cholecystectomy were prospectively enrolled from 2010 to 2020. Three groups were identified: age 70-75 (Group 1); age 76-80 (Group 2); Age > 80 (Group 3). Major postoperative complications were considered as more than grade II according to the Clavien and Dindo classification. Demographic, intra-, and postoperative outcomes were compared. A multivariate analysis was also performed to identify predictive factors of morbidity.
Results:
We reviewed 832 patients: 302 (36.3%) were ≠ 70 y-o. Group 1 accounted for 124 patients (41.1%), group 2 for 74 (24.5%) and group 3 for 104 (34.3%). Male gender was significantly less represented with increasing ages (p<0.001). ASA score >2 (p=0.010), CACI score (p<0.001), and ERD score (p<0.001) were more frequent in group 3. No significant differences were found about AAST distribution and comorbidities. Conversion to open rate was significantly higher in group 1 (6.5%) and group 3 (8.7%) (p=0.019). Common bile duct stones rate was higher in group 3 (14.5% vs 13.5% vs 31.7%; p<0.001). Median postoperative hospital length of stay was increasingly longer (p<0.001). AAST grade ≠ 3 (OR 3.187; 95% CI 1.356-7.489; p=0.008), age ≠ 70 y-o (OR 3.358; p<0.001), and CBD stones (OR 2.912; 95% CI 1.456-5.824; p=0.003) were identified as predictive factors of morbidity between < and ≠ 70 ys. Among the three groups of elderly, age > 80 ys was associated with an increase of OR of postoperative complication by 2.94 (95% CI 1.099-7.912; p = 0.032).
Conclusions:
Laparoscopy can be safely offered in elderly patients, although longer postoperative hospital stay. The presence of associated CBD stones may increase the risk of morbidity.
Key Words:
Acute calculous cholecystitis, Cholecystectomy, Common bile duct lithiasis, Elderly, Frailty, Laparoscopy.
