Clinical scienceAge matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans
Section snippets
Methods
This was a retrospective, cross-sectional analysis of hospital discharge data for 1999 to 2006 from the Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database, which is a stratified 20% sample of all inpatient admissions to nonfederal, acute care hospitals maintained by the Agency for Healthcare Research and Quality. It is the largest all-payer inpatient database in the United States, with records from approximately 8 million hospital stays each year. This study
Results
Of the 1,332,195 adult admissions for biliary disease in the HCUP-NIS database between 1999 and 2006, cholecystectomy was performed as the primary procedure during hospitalization in 145,675 patients aged 50 to 64 years, 149,855 patients aged 65 to 79 years, and 62,561 patients aged ≥80 years. Demographic characteristics of these patients and the characteristics of the biliary tract disease are shown in Table 1.
Among patients aged 65 to 79 and ≥80 years, there was a significantly higher
Comments
In this large study of elderly patients hospitalized for cholecystectomy, older patients (aged 65–79 and ≥80 years) were found to have more complex biliary disease and worse short-term clinical and economic outcomes than a younger comparison group (aged 50–64 years). In particular, patients aged ≥ 80 years had nearly 6 times greater adjusted odds of in-hospital mortality and nearly 11 times the adjusted odds of a nonroutine discharge than patients aged 50 to 64 years. Longer time from hospital
Conclusions
This is the first nationwide study since 1992 to examine clinical and economic outcomes following cholecystectomy among elderly patients. It appears that laparoscopic cholecystectomy has become more prevalent among the elderly, but there has been little progress over time in improving outcomes with regard to the subset of elderly patients who are most vulnerable and require admission to the hospital for the management of their complex biliary disease. More data are needed, including data
References (23)
- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chron Dis
(1987) - et al.
Cholecystectomy in patients aged 80 and older
Am J Surg
(1998) - et al.
What have we learned over the past 20 years in appendicitis in the elderly?
Am J Surg
(2003) - et al.
The natural course of gallstone disease: eleven-year review of 781 nonoperated cases
Gastroenterology
(1966) - et al.
Cholecystectomy in the old
Am J Surg
(1988) - et al.
A most stubborn bias: no adjustment method fully resolves confounding by indication in observational studies
J Clin Epidemiol
(2010) Retooling for an aging America: building the health care workforce
(2008)- et al.
Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer
Eur J Cardiothorac Surg
(2003) - et al.
Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data
Med Care
(2005) US Bureau of Labor Statistics
The significance of discharge to skilled care after abdominopelvic surgery in older adults
Ann Surg
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2021, Clinics in Geriatric MedicinePercutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes
2020, American Journal of SurgeryAssessing long term quality of life in geriatric patients after elective laparoscopic cholecystectomy
2020, American Journal of SurgerySafety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients
2019, HPBCitation Excerpt :Cholecystectomy remains the treatment of choice for symptomatic cholelithiasis, however this procedure in patients >80 years of age may be associated with greater risk, due to greater comorbidities and potentially higher rates of postoperative complications.2 Studies analyzing the results of cholecystectomy in the elderly include a large range of ages with disparate results,2,3 and few have focused on those purely ≥80 years of age.4 In the setting of acute cholecystitis, equipoise exists or these patients between percutaneous gall-bladder drainage vs surgery,5 and the best timing of surgery: early vs delayed.6
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Dr Kuy's work is supported by funding from the Robert Wood Johnson Foundation and the US Department of Veterans Affairs. Dr. Sosa's work was supported in part by a Dennis W. Jahngen Career Development Scholars Award, sponsored by the American Geriatrics Society/John A. Hartford Foundation.