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Age Is Not So Important for Risk Stratification in Early Cholecystectomy for Acute Calculous Cholecystitis: A
Paola Fugazzola1,2, Ahmed Ghaly1,2, Luca Ansaloni1,2
1General Surgery Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Insights
Chronological age is not a reliable predictor of complications after early cholecystectomy for acute calculous cholecystitis. Frailty assessment is more crucial for predicting patient outcomes.
Area of Science:
- Surgical Gastroenterology
- Geriatric Surgery
- Clinical Risk Stratification
Background:
- Early cholecystectomy (EC) is standard for acute calculous cholecystitis (ACC).
- The role of EC in elderly patients remains debated.
- Identifying reliable risk factors for EC outcomes is essential.
Purpose of the Study:
- To investigate if age is an independent risk factor for prognosis after EC in ACC patients.
- To compare the predictive value of age versus other risk scores for postoperative outcomes.
Main Methods:
- Post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study.
- Inclusion of patients with ACC undergoing EC.
- Univariate and multivariate analyses to assess risk factors for major morbidity and mortality.
Main Results:
- Univariate analysis showed age as a significant risk factor for 30-day complications and mortality.
- Multivariate analysis revealed age alone was not a significant predictor (p > 0.05).
- The POSSUM Physiological Score (PS) was the only significant predictor for both 30-day mortality and major morbidity.
Conclusions:
- Age alone is not a reliable predictor of postoperative complications after EC for ACC.
- Patient frailty, not chronological age, should guide outcome prediction.
- The POSSUM Physiological Score is a valuable tool for risk stratification in these patients.
Abstract:
Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients.
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