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Laparoscopic cholecystectomy in the geriatric population

W E Golden1, M A Cleves, J C Johnston

  • 1Arkansas Foundation for Medical Care, F. Smith, USA.

Journal of the American Geriatrics Society
|November 1, 1996
PubMed
Summary
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Laparoscopic cholecystectomy in older adults shows higher conversion rates (up to 28% for acute cases) than in younger populations. These findings are crucial for surgical audit committees assessing proficiency in geriatric patients.

Area of Science:

  • Geriatric Surgery
  • Minimally Invasive Surgery
  • Gastrointestinal Surgery

Background:

  • Laparoscopic cholecystectomy is a common procedure for gallbladder conditions.
  • Older adults represent a growing patient demographic undergoing surgery.
  • Existing literature often focuses on younger populations and elective procedures.

Purpose of the Study:

  • To evaluate the effectiveness and conversion rates of inpatient laparoscopic cholecystectomy in elderly community-dwelling individuals.
  • To compare conversion rates in older adults with published data from younger populations.

Main Methods:

  • Retrospective chart review of 449 geriatric patients undergoing inpatient cholecystectomy in Arkansas (FY 1994).
  • Data collected included procedure type, conversion from laparoscopic to open surgery, complications, and transfusion needs.

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  • Analysis stratified by hospital size and patient demographics.

    • Main Results:

    • Eighty-two percent of non-incidental cholecystectomies were initially laparoscopic.
    • The overall conversion rate was 20%, with 28% for acute cholecystitis cases.
    • Male patients had higher conversion rates for acute disease (40% vs. 19%).
    • Conversion rates for elective procedures were 13-14% and did not vary by hospital size or age group.

    Conclusions:

    • Inpatient laparoscopic cholecystectomy is frequently performed in older adults for both acute and chronic gallbladder disease.
    • Conversion rates in this geriatric cohort are higher than previously reported for younger, elective surgery patients.
    • Surgical audit committees must consider these higher conversion rates when evaluating surgical performance in older patients.