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One-year outcomes of elderly acute cholecystitis patients by index treatment
Núria Lluís1, Celia Villodre2,3, Lucía Guilabert4,3
1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
Insights
Managing acute cholecystitis in elderly patients requires better strategies. Surgery during initial hospitalization may improve one-year outcomes compared to supportive care or drainage for many older adults.
Area of Science:
- Gastroenterology
- Geriatric Medicine
- Surgical Outcomes
Background:
- Acute cholecystitis management in the elderly needs improvement.
- Current strategies may not yield optimal long-term results.
Purpose of the Study:
- To evaluate one-year outcomes after different treatments for acute cholecystitis in patients aged 70 years and older.
- To compare surgical intervention with supportive care and percutaneous gallbladder drainage.
Main Methods:
- Retrospective study of 50 elderly patients with acute cholecystitis.
- Propensity score matching analysis to adjust for demographic and clinical variables.
Main Results:
- One-year rates for additional procedures were 0% for surgery, 47.4% for supportive care (SC), and 72.7% for percutaneous gallbladder drainage (PCGD).
- One-year readmission rates were 0% for surgery, 15.8% for SC, and 50% for PCGD.
- SC and PCGD were associated with higher rates of additional procedures and readmissions compared to surgery.
Conclusions:
- Cholecystectomy during the index hospitalization may offer superior one-year outcomes for elderly patients with acute cholecystitis.
- At least 50% of elderly patients with acute cholecystitis could potentially benefit from early surgical intervention.
Background:
Strategies for managing the elderly with acute cholecystitis need to be refined.
Aims:
To examine additional procedures, hospital readmissions, and outpatient visits in the year following the index admission.
Patients And Methods:
Single-institution retrospective study of fifty consecutive patients aged ≥70 years admitted with acute cholecystitis. A propensity score matching analysis adjusted for demographic and clinical variables was carried out.
Results:
The one-year rates of additional procedures were 0%, 47.4%, and 72.7% for surgery, supportive care (SC), and percutaneous gallbladder drainage (PCGD), respectively. The one-year readmission rate was 0%, 15.8%, and 50% after these index procedures, respectively. After propensity score analysis, patients who received SC (55.6% vs. 0%, P = .03) or PCGD (77.8% vs. 0%, P = .002) had a higher rate of additional procedures compared to those who underwent surgery. Additionally, patients receiving PCGD had a higher readmission rate than those undergoing surgery (55.6% vs. 0%, P = .03). Nine patients who received SC and nine patients who received PCGD could have potentially undergone surgery during the index admission. This would have resulted in improved one-year outcomes.
Conclusion:
Cholecystectomy during the index hospitalization may provide better one-year outcomes than SC or PCGD in at least 50% of patients ≥70 years with acute cholecystitis.
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