Surgery for gallstones in old age: do we operate too late?

Out of 59 patients of 70 years of age or more submitted consecutively to operative treatment for gallstone disease, 25 patients (42%) had histories of more than one year's duration. Jaundice had been present or was observed in 32 patients (54%) and acute cholecystitis was found in 21 (41%). Choledocholithiasis was found in 32 patients (54%). The patients with complications had significantly longer had symptoms of gallstones than patients without complications. The mortality was 12% (7 patients). Four of these were submitted to operation as an emergency and three were submitted to operation subacutely because of deterioration in their general condition. In cases submitted to elective operation the mortality was thus nil. On the basis of these results and review of the literature, it is concluded that complications of gallstone disease are less well tolerated in elderly patients than in younger patients. In cases where elective operation is possible, elderly patients seem to have just as good a prognosis as slightly younger age groups. Our material seems to indicate that, probably because of their age, elderly patients have their operation postponed despite symptoms of gallstones, until a complication occurs. If this is so it might be questioned whether we operate on these patients too late.