Abstract
BackgroundOlder patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients. However, most studies have not considered patient frailty, particularly regarding emergency cholecystectomy. The aim of this prospective study was to evaluate outcomes in frail older patients eligible for elective and emergency cholecystectomy.MethodsPreoperative Geriatric Assessment (GA) was performed in consecutive patients aged 65+ years, operated for biliary disease. The GA evaluated the functional, cognitive, comorbidity, depressive, nutritional, and polypharmacy status and patients with two or more abnormal domains were considered frail. Outcomes of interest were 30-day postoperative mortality, morbidity, and length of hospital stay (LOS).ResultsA total of 126 patients (median age 74; range 65–93 years) were included. There was no difference between elective frail and non-frail patients regarding postoperative mortality (0 %) and morbidity (6 % vs. 5 %; p = 0.76). LOS was not significantly longer in the frail group (5.6 vs. 4 days; p = 0.22). In the emergency-admitted patients, almost all complications occurred in the frail population (mortality 5 % vs. 0 %; morbidity 36.7 % vs. 3.3 %, compared with non-frail patients, respectively; p < 0.01) and LOS was significantly longer (10.3 (frail) vs. 6 days (non-frail);p = 0.03). Frail status was a significant independent predictive factor for postoperative complications in the emergency population, only (odds ratio: 3.4 (1.2–9.7); p = 0.02).ConclusionsElective laparoscopic cholecystectomy is a safe and effective surgical technique also for older frail patients. In emergency settings, frail patients have significantly more complications and a longer LOS. However, the role of severity of frailty and the most reliable GA tools require further study.Trial registrationISRCTN14976998 (retrospectively registered)
Highlights
Older patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients
Several studies, concerning surgical treatment of biliary disease, have shown that older patients more often have complicated gallstone disease, more emergency and open operations, higher postoperative morbidity and mortality rates, and a longer postoperative hospital stay compared with younger patients [1,2,3,4,5,6]
At present, such “patient-related” treatment guidelines do not exist, taking into consideration local pathological changes, patient clinical status and the subsequent treatment decisions [11]. The aim of this prospective study was to evaluate postoperative outcomes in frail older patients eligible for elective and emergency cholecystectomy. This is the first prospective study to assess the outcome of frail older patients undergoing emergency cholecystectomy
Summary
Older patients experience a higher incidence of postoperative complications after cholecystectomy compared with younger patients. Most studies have not considered patient frailty, regarding emergency cholecystectomy The aim of this prospective study was to evaluate outcomes in frail older patients eligible for elective and emergency cholecystectomy. The appropriate assessment can be even more complex in case of patients with acute cholecystitis At present, such “patient-related” treatment guidelines do not exist, taking into consideration local pathological changes, patient clinical status and the subsequent treatment decisions [11]. The aim of this prospective study was to evaluate postoperative outcomes in frail older patients eligible for elective and emergency cholecystectomy. To our knowledge, this is the first prospective study to assess the outcome of frail older patients undergoing emergency cholecystectomy
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