Biliary lithiasis in the elderly patient: morbidity and mortality due to biliary surgery

Diseases of the biliary tract are the most common conditions requiring intra-abdominal surgery in elderly patients. Complications and adverse outcomes of gallstones are more frequent in older people. The present study was undertaken to analyze factors that contributed to overall morbidity and mortality after open cholecystectomy. Laparoscopic surgery and other new techniques were compared with the open method.

We studied retrospectively 76 patients that were 80 years and older. Each patient underwent operation in our unit. 40 patients had fewer than 30 days of clinical history, and 69 patients (90.8%) were emergency admissions. From a clinical point of view, 33 patients (43.4%) had jaundice on arrival and 21 (27.6%) fever. The operative findings included gallbladder wall infection in 46 patients (60.5%) and common bile duct stones in 25. Uni- and multivariate analysis was performed to discriminate variables in mortality and morbidity.

Nine patients (11.8%) died, and 38 had complications in the postoperative period. The main causes of death were pulmonary complications (4) and multisystem organ failure (3). Morbidity was mainly due to wound infection (14), urinary infection (13) and respiratory disease (10). Three variables influenced morbidity: sex (male), cardiovascular disease and jaundice upon admission. In the regression model only cardiovascular disease and jaundice were of independent influence. The mortality rate was associated with pre-operative jaundice.

Mortality and morbidity are related mainly to preoperative presentation. Jaundice is the main determinant of the outcome.