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A Retrospective Comparison of Older and Younger Adults Undergoing Early Laparoscopic Cholecystectomy for Mild to Moderate Calculous Cholecystitis
Author(s) -
Fuks David,
Duhaut Pierre,
Mauvais Francois,
Pocard Marc,
Haccart Vincent,
Paquet JeanChristophe,
Millat Bertrand,
Msika Simon,
Sielezneff Igor,
Scotté Michel,
Chatelain Denis,
Regimbeau Jean Marc
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13330
Subject(s) - medicine , cholecystectomy , randomized controlled trial , cholecystitis , retrospective cohort study , acute cholecystitis , laparoscopic cholecystectomy , young adult , surgery , gallbladder
Objectives To compare the demographic characteristics and intra‐ and postoperative outcomes in elderly adults (≥75) with those of younger adults undergoing early (<5 days after onset of complaints) cholecystectomy. Design Retrospective analysis from M ay 2010 to A ugust 2012. Setting Randomized, multicenter, clinical trial ( ABCAL S tudy, NCT 01015417). Participants Individuals with mild or moderate acute calculous cholecystitis ( ACC ) according to the T okyo G uidelines (N = 414; n = 78 aged 75–94, median 82; n = 336 aged 18–74, median 49). Measurements Demographic characteristics and pre‐, intra‐, and postoperative data. Results The elderly group was more likely to have an A merican S ociety of A nesthesiologists score of 3 or greater (62% vs 23%, P < .001), higher serum creatinine (103 vs 74 μmol/L, P < .001), and more‐severe ACC (moderate ACC (62% vs 50%, P = .05), gangrenous cholecystitis (38% vs 15%, P = .001)) on preoperative imaging and confirmed intraoperatively. Ulcerated mucosa (76% vs 61%, P = .001) was significantly more frequent in the elderly group. Operative time, postoperative mortality, and postoperative infectious (18% vs 14%, P = .35) and noninfectious (9% vs 3%, P = .80) complications were similar between the two groups. Median length of stay (7.0 vs 5.0 days, P = .54) and readmission rate (15% vs 4%, P = .07) were not significantly higher in the elderly group. No significant difference was observed for the subgroup of participants aged 80 and older. Conclusion In this randomized trial that included a selected sample of older adults, there was no difference in major outcomes between elderly adults and their younger counterparts after early cholecystectomy. The findings are limited because important geriatric outcomes such as delirium and functional decline were not examined.