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The influence of age on clinical and patient-reported outcomes after cholecystectomy
E A Mort1, E Guadagnoli, S A Schroeder
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Objective:
To examine the relationship between the age of cholecystectomy patients and surgical complications, length of stay, symptom relief, and postdischarge functional status.
Design:
Patients' medical records were reviewed and patients were sent a questionnaire three months after hospital discharge.
Setting:
Four university-affiliated teaching hospitals.
Patients:
372 patients who had a primary operation of total cholecystectomy.
Outcome Measures:
In-hospital complications, length of stay, patient satisfaction, symptom relief, and functional status after discharge.
Results:
Patients over the age of 60 years experienced a higher major postoperative complication rate than did younger patients (p < 0.01), although the overall major complication rate was too low to determine whether factors other than age were important predictors. There was no age-related difference in minor postoperative complication rates. The older patients had a longer mean length of stay, even after statistical adjustment for covariates (p < 0.05). The older patients reported similar levels of patient satisfaction, but reported recurrence of preoperative abdominal pain less often than did the younger patients (OR = 0.4, 95% CI = 0.2, 0.7). There was no statistically significant difference between the older and younger patients in postoperative functioning, except for work performance. The younger patients reported improvement in postoperative work performance, while the older patients reported a decline (p < 0.01).
Conclusions:
Older cholecystectomy patients may experience more postoperative complications but report less recurrence of preoperative abdominal pain than do younger patients. The decline in work performance in older patients may indicate the need for a longer recuperation period.