Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians

Abstract

Background: The independent influence of advanced age on outcomes in contemporary series treated by early cholecystectomy is undetermined.

Methods: Elderly patients, aged 80 years and older, with histology proven acute cholecystitis treated by cholecystectomy on initial presentation between 2005 and 2011 were compared to all others.

Results: In total, 411 patients had histologically proven acute cholecystitis, of whom 71 (17%) were aged 80 years and older. Elderly patients were more likely to have ischaemic heart disease, underlying diabetes and chronic renal failure. There was greater conversion from laparoscopic to open surgery in the elderly (21% versus 7%; P = 0.001). Elderly patients were more likely to have gangrenous cholecystitis (44% versus 31%; P = 0.033) and common bile duct stones (27% versus 17%; P = 0.048). Elderly patients had more complications (31% versus 13%; P < 0.001), a higher mortality rate (4% versus 1%; P = 0.038) and a longer median post-operative length of stay (7 days versus 3 days; P < 0.001). Age ≥ 80 (P = 0.004) was an independent risk factors for complications.

Conclusion: Age 80 years and older is independently associated with increased morbidity following cholecystectomy for treatment acute cholecystitis at initial presentation.

Keywords: common bile duct stone; laparoscopy complication; morbidity; mortality.