Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy

• Published in: BMC gastroenterology 2023-09, Vol.23 (1), p.1-328, Article 328
• Main Authors: Lee, Cho Eun, Lee, Seung Jae, Moon, Ju Ik, Choi, In Seok, Yoon, Dae Sung, Choi, Won Jun, Lee, Sang Eok, Sung, Nak Song, Kwon, Seong Uk, Bae, In Eui, Roh, Seung Jae, Kim, Sung Gon
• Format: Article
• Language: English
• Subjects: Acute cholecystitis; Age; Aged patients; Aged, 80 and over; Bile ducts; Body mass index; Care and treatment; Cholecystectomy; Cholecystitis; Classification; Comorbidity; Complications and side effects; Diagnosis; Disease; Endoscopy; Gallbladder cancer; Gallbladder diseases; Gallstones; Gastroenterology; Hospitals; Laparoscopic surgery; Laparoscopy; Mortality; Multivariate analysis; Nutritional status; Patient outcomes; Patients; Pleural effusion; Pneumonia; Review boards; Risk factors; Surgery; Surgical outcomes; Surgical site infections; Wound dehiscence
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-023-02954-6

Background Impact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established. Methods This single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 [less than or equal to] age < 80 years), and Group 3 (age [greater than or equal to] 80 years). Risk factors for complications were assessed using logistic regression analysis. Results Of the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3. Conclusion Advanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC. Keywords: Acute cholecystitis, Laparoscopy, Cholecystectomy, Aged, 80 and over