Clinical outcomes of octogenarians according to preoperative disease severity and comorbidities after laparoscopic cholecystectomy for acute cholecystitis.

Abstract

Clinical outcomes of octogenarians with acute cholecystitis treated with laparoscopic cholecystectomy are unclear. This study aimed to compare their outcomes according to preoperative severity and comorbidities. Medical charts of 120 octogenarians who underwent laparoscopic cholecystectomy for acute cholecystitis between January 2008 and December 2017 at Asan Medical Center, Seoul, Korea, were retrospectively reviewed. Based on the Tokyo Guidelines 2018 (TG 18), patients had mild (n=35), moderate (n=61), or severe (n=24) disease. We investigated postoperative outcomes, comorbidities, and prognostic factors of ≥grade III complications. Total antibiotic use duration (P=.024), operative times (P=.002), additional port insertion (P=.012), and postoperative hospital stay (P=.018) were significantly higher in the severe group. There were no statistically significant differences in total or grade III or higher complications (P=.304) or mortality (P=.476). On multivariate analysis, pulmonary disease predicted Clavien-Dindo classification ≥grade III complications (odds ratio 37.075; 95% confidence interval 5.734-239.695; P<.001). In octogenarians, laparoscopic cholecystectomy is feasible and tolerable for severe acute cholecystitis classified according to the TG 18. Pulmonary comorbidities are an independent prognostic factor of ≥grade III complications.