Short- and long-term predictive power of the preoperative Geriatric Assessment components in older patients undergoing cholecystectomy.

Abstract

Introduction: Increasing numbers of older patients will require laparoscopic cholecystectomies. Physicians may have doubts when qualifying these patients for elective surgeries, since older age is considered a risk factor for complications. Determining biological age, using a Geriatric Assessment (GA), should be the key factor in the preoperative assessment. The goal of this study was to determine which GA components are most useful for predicting postoperative outcomes in both short- and long-term follow-up.Materials and Methods: 219 consecutive patients aged ≥70 years underwent surgery and were followed-up prospectively for 12 months. The preoperative GA consisted of functionality, physical activity, comorbidity, polypharmacotherapy, nutrition, cognition, mood, and social support domain. Logistic regression analyses were used to analyse the predictive ability of the GA. Results: GA, frailty and chronological age were not predictive of major 30-day morbidity. There were significantly more overall postoperative complications in the frail group, mainly minor and medical. There were no significant differences in the rate of major and surgical complications between frail and fit patients. Only frailty was a predictor of 1-year mortality. Conclusion: Performing GA before elective laparoscopic cholecystectomies seems unnecessary for the evaluation of short-term outcomes but helpful for the assessment of long-term outcomes. Laparoscopic cholecystectomy can be safely performed also in older frail patients.