Clinical science
Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans

https://doi.org/10.1016/j.amjsurg.2010.04.018Get rights and content

Abstract

Background

Gallstone disease increases with age. The aims of this study were to measure short-term outcomes from cholecystectomy in hospitalized elderly patients, assess the effect of age, and identify predictors of outcomes.

Methods

This was a cross-sectional analysis, using the Health Care Utilization Project Nationwide Inpatient Sample (1999–2006), of elderly patients (aged 65–79 and ≥80 years) and a comparison group (aged 50–64 years) hospitalized for cholecystectomy. Linear and logistic regression models were used to evaluate age and outcome relationships. Main outcomes were in-hospital mortality, complications, discharge disposition, mean length of stay, and cost.

Results

A total of 149,855 patients aged 65 to 79 years, 62,561 patients aged ≥ 80 years, and 145,675 subjects aged 50 to 64 years were included. Elderly patients had multiple biliary diagnoses and longer times to surgery from admission and underwent more open procedures. Patients aged 65 to 79 years and those aged ≥80 years had higher adjusted odds of mortality (odds ratios [ORs], 2.36 and 5.91, respectively), complications (ORs, 1.57 and 2.39), nonroutine discharge (ORs, 3.02 and 10.76), longer length of stay (ORs, 1.11 and 1.31), and higher cost (ORs, 1.09 and 1.22) than younger patients.

Conclusions

Elderly patients undergoing inpatient cholecystectomy have complex disease, with worse outcomes. Longer time from admission to surgery predicts poor outcome.

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

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      Citation 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.

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