Outcome after cholecystectomy in the elderly: a population-based register study

Abstract

Objective: The decision to perform surgery in elderly is usually based on a complex consideration of benefit versus risk, which makes it difficult to perform controlled trials. The aim of this study was to assess the safety of cholecystectomy in patients aged 80 years and above. Methods: The study was based on the Swedish National Register for Gallstone Surgery and ERC (GallRiks) 2006–2011. The cohort was cross-linked with the Swedish Patient Register in order to obtain data on previous medical history and postoperative events. Date and cause of death were obtained from the Central Death Register. All events with an ICD code indicating myocardial infarct, cerebrovascular insult or pulmonary embolism within 30 days postoperatively were considered to be a cardiovascular event. Poisson regression was used to calculate the 30-day age- and sex-adjusted standardised mortality ratio (SMR). Results: Altogether 1961 procedures in patients aged 80 years and above were registered. A cardiovascular event within 30 days after the procedure was registered in 56 (0.20%) of the cases. Mortality within 30 days was n = 56 (0.20%). The SMR was 4.07 (CI 3.07–5.28). In univariate regression analyses, no factor was found to significantly predict a postoperative cardiovascular event. Gallstone disease without secondary complication, and open approach were associated with increased risk for death within 30 days after surgery in both univariate and multivariate regression analyse (p < 0.05). Conclusion: Cholecystectomy seems to be a relatively safe procedure in patients aged 80 years or older. Minimally invasive techniques may reduce the risk of postoperative death.