Abstract
Background
The number of Danish inhabitants older than 65 years is increasing, and cholecystectomy is one of the most common surgical procedures performed for this age group. This study aimed to analyze the role of age as an independent predictor of outcome for elderly cholecystectomy patients.
Methods
Data from the Danish Cholecystectomy Database (2006–2010) were used. The outcomes of interest were conversion rate for laparoscopic cholecystectomy, outpatient rate, postoperative hospital length of stay, readmission rate, and frequency of additional procedures and death within 30 days postoperatively.
Results
In this study, 697 patients 80 years of age or older and 4,915 patients ages 65–70 years were compared with 8,805 patients ages 50–64 years. Significantly more patients age 80 years or older underwent surgery for acute cholecystitis, and the conversion rate from laparoscopic to open surgery was significantly higher in the oldest group. The older patients had longer postoperative hospital stays, but nearly 30 % of the patients age 80 years or older were admitted for only 0–1 day and not readmitted, and nearly half of the patients were admitted for only 0–3 days without readmission. Also, the mortality rate and the number of patients who underwent additional procedures within 30 days were higher in the oldest group (6 vs 0.1 and 28 vs 15 %, respectively). A subanalysis of the patients age 80 years or older classified as American Society of Anesthesiology 1 and 2 without acute cholecystitis showed that 44 % left the hospital within 1 day and 63 % within 3 days without readmission and that the 30-day mortality rate was only 2 %.
Conclusions
Age is an independent predictor for worse outcome after cholecystectomy. However, among otherwise healthy patients age 80 years or older who underwent surgery before acute inflammatory complications occurred, 63 % had a fast and uncomplicated course. Thus, it seems fair to recommend elective laparoscopic cholecystectomy when repeated gallstone symptoms have occurred also for the older patient, particularly before the patient experiences acute cholecystitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Befolkningsfremskrivninger 2011–2050. Befolkning og valg (population projections 2011–2050: population and decisions) NYT fra Danmarks statistik nummer 205. http://www.dst.dk/pukora/epub/Nyt/2011/NR205.pdf. Accessed 4 May 2011
Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ (2001) Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc 15:700–705
Reiss R, Deutsch AA (1985) Emergency abdominal procedures in patients above 70. J Gerontol 40:154–158
Kuy S, Sosa JA, Roman SA, Desai R, Rosenthal RA (2011) Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg 201:789–796
Weber D (2003) Laparoscopic surgery, an excellent approach in elderly patients. Arch Surg 138:1083–1088
Maxwell JG, Tyler BA, Rutledge R, Brinker CC, Maxwell BG (1998) Cholecystectomy in patients aged 80 and older. Am J Surg 176:627–631
Maxwell JG, Tyler BA, Maxwell BG, Brinker CC, Covington DL (1998) Laparoscopic cholecystectomy in octogenarians. Am Surg 54:826–831
Uecker J, Adams M, Skipper K, Dunn E (2001) Cholecystitis in the octogenarian: is laparoscopic cholecystectomy the best approach? Am Surg 67:637–640
Pessaux P, Tuech J-J, Derouet N, Rouge C, Regenet N, Arnaud J-P (2000) Laparoscopic cholecystectomy in the elderly. Surg Endosc 14:1067–1069
Huber FD, Martin EW, Cooperman M (1983) Cholecystectomy in elderly patients. Am J Surg 146:719–722
Harboe KM, Anthonsen K, Bardram L (2009) Validation of data and indicators in the Danish Cholecystectomy Database. Int J Qual Health Care 21:160–168
Harboe KM, Bardram L (2011) The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc 25:1630–1641
Harboe KM, Bardram L (2011) Nationwide quality improvement of cholecystectomy: results from a national database. Int J Qual Health Care 23:565–573
The Danish National Board of Health (2006) Referenceprogram for behandling af patienter med galdestenssygdomme (guidelines for treatment of patients with gallstones disease). http://www.sst.dk/publ/Publ2006/PLAN/SfR/Galdesten/Galdestenssygdomme.pdf. Accessed 12 Jan 2006
Tucker JJ, Yanagawa F, Grim R, Bell T, Ahuja V (2011) Laparoscopic cholecystectomy is safe but underused in the elderly. Am Surg 77:1014–1020
Magnuson TH, Ratner LE, Zenilman ME, Bender JS (1997) Laparoscopic cholecystectomy: applicability in the geriatric population. Am Surg 63:91–96
Kuwabara K, Matsuda S, Fushimi K, Ishukawa KB, Horiguchi H, Fujimori K (2011) Relationships of age, cholecystectomy approach, and timing with the surgical and functional outcomes of elderly patients with cholecystitis. Int J Surg 9:392–399
Bergman S, Sourial N, Vedel I, Hanna WC, Fraser SA, Newman D, Bilek AJ, Galatas C, Marek JE, Monette J (2011) Gallstone disease in the elderly: are older patients managed differently? Surg Endosc 25:55–61
Disclosures
Liv Bjerre Juul Nielsen, Kirstine Moll Harboe, and Linda Bardram have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nielsen, L.B.J., Harboe, K.M. & Bardram, L. Cholecystectomy for the elderly: no hesitation for otherwise healthy patients. Surg Endosc 28, 171–177 (2014). https://doi.org/10.1007/s00464-013-3144-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3144-8