Abstract
BackgroundElderly patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards.MethodsThis retrospective study included all patients > 65 years admitted for acute cholecystitis between January, 2009 and September, 2016. Data were retrieved from the electronic health records.ResultsA total of 187 patients were detected, 54 (29%) in medical departments and 133 (71%) in surgical wards. The mean age (±SD) was 80 ± 7.5 and was higher among those in medical than surgical wards (84 ± 7 versus 79 ± 7, p < 0.05). Patients hospitalized in medical departments had more comorbidity, disability and mental impairment. However, there was no difference in mortality between the two groups, 1 (2%) and 6 (4%) respectively. Independent predictors for hospitalization in medical departments were chronic obstructive pulmonary disease (OR = 9.8, 95% C. I 1.6–59) and the Norton Scale score (NSS)(OR = 0.7, 95% C. I 0.7–0.8). Impaired mental condition was the only predictor for hospitalization > 1 week. The strongest predictor for having cholecystostomy was admission to the surgical department (OR = 14.7, 95% C. I 3.9–56.7). Linear regression showed a negative correlation between NSS and length of hospitalization (LOH; Beta = − 0.5).ConclusionElderly patients with acute cholecystitis who require conservative management, especially those with severe functional and mental impairment can be safely hospitalized in medical departments. Outcome was not inferior in terms of mortality and LOH. These results have practical policy implications for the placement of elderly patients with acute cholecystitis in medical rather than surgical departments.
Highlights
Acute cholecystitis is a common clinical condition usually precipitated by cystic duct obstruction by a stone [1]
The current study focused on acute cholecystitis, we believe it serves as template for further studies to assess elderly patients with other, traditionally surgical diagnoses admitted to medical versus surgical departments
We believe these findings facilitate embracing a new policy of admission of elderly patients with acute cholecystitis to medical departments, especially for those who are poor surgical candidates on account of multiple co-morbidities. In order that these data and insights lead to a generally accepted change of policy there is need for a prospective, longterm study to evaluate readmissions, morbidity and mortality and surgical interventions that may occur after the initial hospitalization. This is the first study to compare the outcomes of elderly patients with a surgical diagnosis admitted to medical and surgical wards
Summary
Acute cholecystitis is a common clinical condition usually precipitated by cystic duct obstruction by a stone [1]. Advanced age is a risk factor for acute cholecystitis and most cases occur in older adults (50–70%) [2, 3]. These patients are usually admitted to a general surgical ward for medical treatment which includes intravenous fluids, antibiotics, restriction of oral intake and analgesics. The common practice is to discharge patients for subsequent elective laparoscopic cholecystectomy; operation during the initial admission is exceptional. Patients admitted because of acute cholecystitis are usually not operated during their initial admission and receive conservative treatment. To help formulate a new admission policy regarding elderly patients with acute cholecystitis we compared the demographic and clinical characteristics and outcome of patients > 65 with acute cholecystitis admitted to medical or surgical wards
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