Surgical risks of acute cholecystitis in elderly

Abstract

Background/aims: For the elderly patient, an emergency biliary procedure carries a higher risk than an elective operation. Recently introduced advances in ultrasonography and critical care medicine have affected the clinical risks of surgery for acute cholecystitis in the elderly. This study evaluated the clinical risks of open cholecystectomy for the elderly with acute cholecystitis.

Materials and methods: During a 10 year period (1985-1994), a total of 145 patients were diagnosed with acute cholecystitis and underwent cholecystectomy. According to their age, the patients were divided into 3 groups (Group A < 59 years of age; Group B between 60-69 years of age; Group C > 70 years of age). The characteristics and the surgical risk factors in open cholecystectomy for the elderly with acute cholecystitis were evaluated.

Results: The rate of acalculous cholecystitis and choledochal stones were significantly (p < 0.05) high in Group C. Septic complication, gangrenous changes, and positive bile culture were also increased parallel to the increase in age. A noteworthy finding was an incidental carcinoma found in a case in group B and in 3 cases in group C. Hospital stay was significantly longer in Group C than in the other groups due to pre-operative complications and post-operative morbidity.

Conclusion: With respect to increase in elderly patients with acute cholecystitis who present more frequent gangrenous changes and carcinomatous changes as well as high rate of septic complication, successful treatment of these patients is increased when early surgery can be performed on the basis of accurate and prompt diagnosis using imaging modalities and meticulous peri-operative management.